Social-Affective Vulnerability to Suicidality among LGBTQ Young Adults: Proximal and Distal Factors

项目摘要/摘要 年轻人的自杀想法和行为(STB)的比率已经达到了危机水平，特别是对于 LGBTQ(即女同性恋者、男同性恋者、双性恋者、同性恋者、怀疑者和/或变性者)人口中的那些面临 除了典型的发展挑战之外，还有社会耻辱。尽管我们知道一般的风险因素 自杀，这些在预测自杀如何发生、何时发生以及发生在谁身上的效用有限。这是至关重要的 考虑社会背景的作用很重要，因为STB经常发生在对最近的社会威胁的反应中 事件，如拒绝，可能更有可能发生在那些改变了神经社会回路敏感度的人身上。 针对RFA MH-20-327的拟议R01研究建立在诸如少数群体压力等社会模型的基础上 自杀理论和人际理论，从远端到近端考察STB的社会危险因素 级别。总体目标是预测STB的变化，包括STB的累积强度和过渡 从自杀念头到行为，时间从几小时到几天再到几个月。我们在LGBTQ中提出 年轻人，性传播障碍是通过社会加工和调节社会产生的负面影响而发生的(例如， 羞耻)。具体地说，我们研究了社交大脑回路中敏感性的远端脆弱性因素 消极紧迫感，或面对痛苦的负面情绪时冲动行为的倾向，以及 睡眠失调和社会经历的近端、时变因素(例如，拒绝)。这项研究将测试 这些远端和近端因素与STB的关系；LGBTQ中这些因素的差异 患有STB的年轻人与没有STB的年轻人；远端和近端因素的相互作用；以及LGBTQ相关的作用 机顶盒的特征(例如，受害、外向)。 这项研究将包括130名年龄在18岁至30岁之间的参与者，他们都认为自己是LGBTQ，其中三分之二的人 反复出现的自杀意念和终生自杀行为史。参与者将完成一份详细的 STB访谈，使用社会威胁范式进行功能磁共振扫描，为期3个月的行动记录方案和 基于智能手机的评估，并在6个月后进行后续采访。智能手机数据将包括生态 即时评估社会威胁体验和STB，以及被动收集的传感器数据(例如， 社交媒体应用程序的使用、短信活动)。传统和机器学习的量化技术将是 用于确定远端和近端因素对STB的贡献(例如，自杀行为的发生)， 风险因素的个体差异，以及神经、睡眠、社会、临床和人口统计学的贡献 影响STB的因素。这项研究将阐明可改变的危险因素在STB中的作用，并具有临床意义 神经科学、自杀学和预防努力。

Project Summary/Abstract Rates of suicidal thoughts and behaviors (STB) among young adults have reached a crisis level, especially for those in the LGBTQ (i.e., lesbian, gay, bisexual, queer, questioning and/or transgender) population, who face social stigma in addition to the typical developmental challenges. Although we know the general risk factors for suicide, those have limited utility in predicting how, when, and in whom suicide occurs. It is critically important to consider the role of social context because STB often occurs in response to a recent social threat event such as rejection and could be more likely in those who have altered sensitivity of neural social circuitry. The proposed R01 study in response to RFA MH-20-327 builds on social models such as Minority Stress Theory and the Interpersonal Theory of Suicide and examines social risk factors of STB from distal to proximal levels. The overarching goal is to predict change in STB, including cumulative intensity of STB and transition from suicidal thoughts to behaviors, on a time scale from hours to days to months. We propose that in LGBTQ young adults, STB occurs through social processing and regulation of socially generated negative affect (e.g., shame). Specifically, we examine the distal vulnerability factors of sensitivity in social brain circuitry and negative urgency, or the tendency toward impulsive behavior in the face of painful negative affect, and the proximal, time-varying factors of sleep dysregulation and social experiences (e.g., rejection). The study will test the association of these distal and proximal factors with STB; differences in these factors between LGBTQ young adults with vs. without STB; the interplay of distal and proximal factors; and the role of LGBTQ-related characteristics (e.g., victimization, outness) in STB. The study will include 130 participants age 18-30, all of whom identify as LGBTQ and 2/3 of whom have recurrent suicidal ideation and lifetime history of suicidal behavior. Participants will complete a detailed interview of STB, an fMRI scan using social threat paradigms, a 3-month protocol of actigraphy and smartphone-based assessment, and a follow-up interview at 6 months. Smartphone data will include ecological momentary assessment of social threat experiences and STB, as well as passively collected sensor data (e.g., social media app use, texting activity). Traditional and machine learning quantitative techniques will be applied to determine contributions of distal and proximal factors to STB (e.g., occurrence of suicidal behavior), individual differences in risk factors, and contributions of neural, sleep, social, clinical, and demographic factors to STB. The study will elucidate the role of modifiable risk factors in STB and have relevance to clinical neuroscience, suicidology, and prevention efforts.