Dynamic Regulatory Processes in the Transition from Suicidal Ideation to Action: The Roles of Cognitive Control, Emotion-Related Impulsivity, and Sleep in the Context of Negative Affective Experiences

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Project Abstract Few NIMH-funded studies have examined contributors to short-term, within-person changes in suicidal ideation and odds of suicidal behavior. We propose to use multi-modal assessments (self-report, behavior, actigraphy) to capture changes in several RDoC domains relevant to suicide risk. In an ideation-to-action framework, we differentiate acute risk factors for suicidal thoughts from those that contribute to the transition from suicidal ideation to behavior. We will test our theoretical model using a 28-day intensive longitudinal design in a sample of suicidal adults leaving inpatient behavioral health care, a population at particularly high risk for suicide. Aim 1: Examine a set of transtheoretical risk factors as proximal predictors of within-person changes in suicidal thoughts. Using ecological momentary assessment, we will gather repeated measures of seven hypothesized ideation risk factors, as well as a dimensional measure of ideation, to model lagged relationships between affective risk factors and subsequent ideation. We expect that each affective risk factor will show a positive association with subsequent increases in suicidal ideation, and that these risk factors will co-occur in daily life such that they are best conceptualized as a single latent construct capturing emotional suffering (psychache). Aim 2: Test self-report and behavioral measures of inhibitory control as risk factors for suicidal behavior. We expect that participants who, at baseline, report greater emotion-related impulsivity, and who show impaired response inhibition in a behavioral task using negative valence stimuli, will have higher odds of suicide attempt over follow-up. Using a novel mobile adaptation of an inhibitory control task during the ecological momentary assessment period, we expect that within-person decrements in inhibitory control will precede within-person increases in likelihood of suicide attempt among individuals thinking of suicide. Aim 3: Evaluate objectively measured sleep duration as a proximal risk factor for both suicidal ideation and suicidal behavior. Using wrist-worn actigraphy devices, we will examine how short sleep duration, compared to participants’ average sleep, relates to next-day ideation and attempts. We expect that short sleep duration will predict within-person increases in suicidal thoughts, as well as increased likelihood of suicide attempts, controlling for suicidal ideation. Finally, we will test an exploratory hypothesis, that the sleep-suicide attempt association is explained by sleep-related decreases in inhibitory control in the context of negative affect. Findings from this study will elucidate modifiable affective, cognitive, and physiological targets for just-in-time, mobile interventions to prevent suicide.