Biological/behavioral rhythms and suicidal behavior: A real-time monitoring study

项目摘要/摘要 自杀是青少年和年轻人的第二大死因。为了更好地预测和 防止自杀想法和行为(STB)，识别近端的、跨诊断的危险因素 作为可行的治疗目标是迫切需要的。睡眠障碍就是这样一个危险因素， 但对睡眠和性传播疾病相关的原因还缺乏了解。为了更好地理解两者之间的联系 睡眠和STB，需要完整的24小时休息-活动周期的数据，包括在清醒时发生的活动 几个小时。睡眠和白天活动的改变是精神障碍的跨诊断特征，两者都是 受复杂的生物和行为节律系统的调节。然而，这些变量很少有 同时或在STBS的背景下进行了研究。在这个项目中，24小时休息之间的假设联系- 活动周期和STB将使用最近的技术进步(即，可穿戴传感器， 智能手机)来实时监控这些过程。一个有自杀倾向的青少年样本 (n=100)将在住院期间招募，并在住院后四周的高风险期间进行随访 句号。主要研究目的有三个：(1)研究与自杀有关的休息活动的表型 研究期间的构思/尝试，并检查休息-活动变量所贡献的唯一差异 预测性传播疾病与其他众所周知的因素(例如，抑郁)相比较，(2)检查日常联系 在休息活动和短暂性脑脊髓炎之间建立联系和近端方向性的强度，以及(3) 探索具体的(即，个人层面的)结果，以检查参与者之间的质量差异，a 最近用于确定个性化治疗靶点的方法。该项目的结果将提供细粒度的 洞察假定的跨诊断风险因素和STB之间的动态，并将有助于阐明 这些因素作为候选人计划的R01的近距离治疗目标的可行性。随行的 培训计划旨在确保当前项目的成功，并支持候选人的成长 独立的研究计划，侧重于理解、预测和干预短期 通过在以下四个领域建立专门知识来应对自杀风险：(1)设计、实施和管理实时监测 在高危青少年中进行研究，(2)获得进行密集处理和分析所需的统计技能 纵向数据，(3)扩大内容领域的专业知识，在生物和行为节律方面调节其余部分- 活动周期和相关流程，以及(4)通过获取发展方面的知识为未来的R01做准备 为青少年提供技术提供的个性化干预措施。这次K23考试将在哈佛大学举行 大学导师：马修·诺克博士，世界领先的青少年自杀研究人员， 共同导师埃文·克莱曼博士，他在收集和分析实时监测数据方面拥有技术专长； 顾问Rosalind Picard博士，使用可穿戴传感器研究和干预的专家 精神病理学，以及研究时间生物学和睡眠的顾问弗兰克·舍尔博士。

Project Summary/Abstract Suicide is the second leading cause of death among adolescents and young adults. To better predict and prevent suicidal thoughts and behaviors (STBs), identification of proximal, transdiagnostic risk factors that would serve as viable treatment targets is critically needed. Sleep disturbances represent one such risk factor, but understanding of why sleep and STBs are associated is lacking. To better understand the link between sleep and STBs, data are needed on the full 24-h rest-activity cycle, including activity occurring during waking hours. Alterations in sleep and daytime activity are transdiagnostic features of mental disorders, and are both regulated by a complex system of biological and behavioral rhythms. However, these variables have rarely been studied simultaneously or in the context of STBs. In this project, the putative link between the 24-h rest- activity cycle and STBs will be examined using recent advances in technology (i.e., wearable sensors, smartphones) to monitor these processes as they unfold in real-time. A sample of suicidal adolescents (N=100) will be recruited during hospitalization and followed over the high-risk four-week post-hospitalization period. There are three primary research aims: (1) Examine phenotypes of rest-activity associated with suicidal ideation/attempt over the study period, and examine the unique variance contributed by rest-activity variables predicting STBs compared to other well-known factors (e.g., depression), (2) Examine day-to-day associations between rest-activity and STBs to establish strength of associations and proximal directionality, and (3) Explore idiographic (i.e., individual-level) results to examine qualitative differences between participants, a method recently used to identify personalized treatment targets. Results from this project will provide granular insight into the dynamics between putative transdiagnostic risk factors and STBs, and will shed light on the viability of these factors as proximal treatment targets for the candidate’s planned R01. The accompanying training plan is designed to ensure success of the current project and to support growth of the candidate’s independent program of research focused on understanding, predicting, and intervening upon short-term suicide risk by building expertise in four areas: (1) Designing, implementing and managing real-time monitoring studies among high-risk adolescents, (2) Acquiring statistical skills needed to process and analyze intensive longitudinal data, (3) Expanding content-area expertise in biological and behavioral rhythms regulating the rest- activity cycle and related processes, and (4) Preparing for a future R01 by gaining knowledge in development of technology-delivered, personalized interventions for adolescents. This K23 will take place at Harvard University under the mentorship of: mentor Dr. Matthew Nock, a world-leading adolescent suicide researcher, co-mentor Dr. Evan Kleiman, who has technical expertise in collecting and analyzing real-time monitoring data; consultant Dr. Rosalind Picard, an expert in using wearable sensors to study and intervene on psychopathology, and consultant Dr. Frank Scheer, who studies chronobiology and sleep.