Nocturnal wakefulness, cognitive control, and suicidal urges: A prospective evaluation of variance during residential treatment

夜间觉醒、认知控制和自杀冲动：住院治疗期间方差的前瞻性评估

• 批准号: 10308100
• 负责人: Keith Eric Bredemeier
• 金额: $ 24.38万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-01 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10308100
• 关键词: Adult; Age; Applied Research; Behavior; Behavioral; Clinic; Controlled Environment; Data; Detection; Development; Dimensions; Disease; Ecological momentary assessment; Environment; Ethnic Origin; Evaluation; Feeling suicidal; Fostering; Future; Gender; General Population; Goals; Hour; Impairment; Individual; Intervention; Investigation; Lead; Link; Mattresses; Measures; Mediating; Mediator of activation protein; Mental Depression; Methodology; Methods; Monitor; Movement; Nightmare; Participant; Patient Self-Report; Patients; Performance; Play; Population; Post-Traumatic Stress Disorders; Public Health; Race; Reaction Time; Reporting; Research; Research Domain Criteria; Residential Treatment; Risk; Risk Factors; Role; Sampling; Severities; Signal Transduction; Sleep; Sleep Disorders; Sleep disturbances; Sleeplessness; Suicide; Suicide attempt; Suicide prevention; Symptoms; Task Performances; Technology; Testing; Time; Veterans; Wakefulness; Work; awake; base; classification algorithm; cognitive control; cognitive task; high risk; improved; indexing; prospective; recruit; relating to nervous system; sensor; suicidal; suicidal behavior; suicidal morbidity; suicidal risk; suicide rate

Project Summary/Abstract Alterations in nocturnal wakefulness and cognitive control are both associated with suicidal thoughts and behaviors in cross-sectional research, but given the methodological limitations of this work, the role that these alterations play in proximal suicide risk remains unclear. We propose to intensively assess veterans with insomnia and suicidal ideation recruited from a posttraumatic stress disorder (PTSD) residential unit to explore the associations among nocturnal wakefulness, cognitive control, and suicide risk. We also anticipate that the associations observed between nocturnal wakefulness, cognitive control, and suicidal ideation will not be exclusive to PTSD, but that PTSD serves as an ideal population in which to test these associations given the importance of disturbances in nocturnal wakefulness, cognitive control, and suicidal ideation among patients with the disorder. The aims are: Aim 1: To evaluate associations between nocturnal wakefulness and suicide ideation prospectively, in veterans with PTSD. Hypothesis 1: Longer duration of nocturnal wakefulness, as indexed by minutes awake from 11 PM – 7 AM based on movement on the mattress sensor strip, will be associated with higher next-day suicidal ideation, above and beyond the influence of PTSD and depression severity, baseline sleep disorder symptoms, and demographic variables (e.g., age, gender, race/ethnicity). Aim 2: To evaluate associations between cognitive control and suicidal ideation prospectively, in veterans with PTSD. Hypothesis 2: Reduced cognitive control (daily cognitive task performance, completed in the morning hours and when awake at night) will be associated with higher subsequent suicidal ideation, above and beyond the influence of PTSD and depression severity, baseline cognitive control performance, and demographic variables. Aim 3: To evaluate evidence for cognitive control as a mediator of the association between nocturnal wakefulness and suicidal ideation prospectively, in veterans with PTSD. Hypothesis 3: The association between nocturnal wakefulness and suicidal ideation will be partially mediated by reduced cognitive control performance. This R21 will support a subsequent R01 project to test an algorithm for the classification of suicidal ideation and behavior based on alterations in nocturnal wakefulness and cognitive control, utilizing methods from this proposal as well as additional levels of analysis (e.g., neural activation). We plan for the results of the proposed project to inform a new line of applied research that will directly utilize our results to develop new ecological momentary intervention strategies aimed at mitigating proximal suicide risk.

项目总结/摘要 夜间觉醒和认知控制的改变都与自杀想法有关， 行为在横断面研究，但鉴于这项工作的方法限制，这些作用， 改变在近端自杀风险中的作用尚不清楚。我们建议对退伍军人进行深入评估， 失眠和自杀意念招募从创伤后应激障碍（PTSD）的住宅单位，以探讨 夜间觉醒、认知控制和自杀风险之间的关系。我们还预计， 在夜间觉醒、认知控制和自杀意念之间观察到的关联将不会被 创伤后应激障碍，但创伤后应激障碍作为一个理想的人口中，以测试这些协会鉴于 脑卒中患者夜间觉醒、认知控制和自杀意念障碍的重要性 紊乱其目标是： 目的1：前瞻性评估夜间觉醒与自杀意念之间的关系， 患有创伤后应激障碍的退伍军人假设1：夜间觉醒的持续时间更长，以清醒分钟数为指标 从晚上11点到早上7点，基于床垫传感器条上的运动，将与第二天的更高 自杀意念，超出PTSD和抑郁严重程度的影响，基线睡眠障碍 症状和人口统计学变量（例如，年龄、性别、种族/民族）。 目的2：前瞻性评估认知控制与自杀意念之间的关联， 创伤后应激障碍假设2：认知控制能力下降（日常认知任务表现，在早上完成） 在晚上醒来时）将与随后的自杀意念较高，超过 PTSD和抑郁严重程度、基线认知控制表现和人口统计学变量的影响。 目的3：评估认知控制作为夜间睡眠与睡眠障碍之间关联的中介的证据。 在患有创伤后应激障碍的退伍军人中，假设3： 夜间觉醒和自杀意念将部分地由降低的认知控制性能介导。 该R21将支持后续R 01项目，以测试自杀意念分类算法 以及基于夜间觉醒和认知控制的改变的行为， 建议以及其他分析级别（例如，神经激活）。我们计划的结果， 项目通知一个新的应用研究，将直接利用我们的成果，以开发新的生态 旨在降低近端自杀风险的瞬时干预策略。