Decision Processes of Late-Life Suicide: Competitive Renewal

晚年自杀的决策过程：竞争更新

• 批准号: 10447042
• 负责人: Katalin Szanto
• 金额: $ 68.65万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10447042
• 关键词: Accounting; Address; Affect; Age; Age-associated memory impairment; Amygdaloid structure; Anthropology; Behavior; Behavior assessment; Behavioral; Butter; Case-Control Studies; Characteristics; Clinical; Clinical assessments; Cognitive; Computer Models; Cues; Data; Decision Making; Dependence; Depressed mood; Depression and Suicide; Disease susceptibility; Elderly; Emotional; Empathy; Epidemic; Ethics; Event; Experimental Designs; Feeling suicidal; Functional Imaging; Funding; Goals; Heterogeneity; Image; Impaired cognition; Impairment; Impulsivity; Individual; Introversion; Investigation; Lead; Learning; Link; Longitudinal Studies; Measures; Medical; Mental Depression; Methods; Modeling; Morals; Motivation; Nature; Neurocognitive; Neuropsychology; Neurosciences; Neurotic Disorders; Nucleus Accumbens; Pathway interactions; Patient Self-Report; Personality; Personality Traits; Persons; Plant Roots; Predisposition; Procedures; Process; Psychological reinforcement; Recording of previous events; Research; Retirement; Rewards; Risk; Risk Factors; Role; Sampling; Social Dominance; Social Network; Social status; Stimulus; Subgroup; Suicide; Suicide attempt; Suicide prevention; Testing; Validation; Work; age related; base; behavioral study; case control; cognitive control; cognitive testing; cohort; coping; design; disability; emotional factor; experience; follow-up; geriatric depression; high risk; human old age (65+); ideation; imaging study; indexing; neuropsychiatric symptom; neurotransmission; older men; predictive modeling; prospective; recruit; relating to nervous system; response; social; social defeat; social deficits; social relationships; stem; suicidal; suicidal behavior; suicidal morbidity; suicidal risk; suicide attempter; theories; trait impulsivity; translational neuroscience; willingness

ABSTRACT This is a competitive renewal of a longitudinal study of late-life suicide. Our ultimate aim is the greater understanding of decision processes that underlie suicidal behavior in old age. Toward this goal, we have accrued a high-risk cohort of depressed older adults (including 173 with past suicide attempts and 82 with serious suicidal ideation) with prospectively ascertained high rates of suicidal behavior. AIM 1. To date, we have shown robust associations between decision process alterations and cognitive control deficits on one hand, and the history of suicidal behavior, on the other, consistent with the notion that these impairments undermine the search for constructive alternatives to suicide. As a crucial next step, we will confirm these associations prospectively through prediction of incident suicide attempts and death by suicide. We predict that decision indices will have predictive power after accounting for recent suicidal ideation. To identify the most useful predictors of incident suicidal behavior, we will also develop a parsimonious prediction model based on a broad range of potential risk factors. AIM 2. Our studies to date have focused on decision-making in non-social contexts. However, many precipitants and deterrents to suicide are rooted in social relationships. In a suicidal crisis, people often fail to consider how devastating their suicide would be for those around them. Normative age-related events affecting social status, such as disability or retirement, may trigger suicidal behavior in late life in a predisposition- dependent manner. To probe the mechanisms underlying catastrophic decisions in response to loss of social dominance, we propose a study of social decision-making involving a loss-of-status manipulation. In addition, we propose to test whether blunted motivational effects of social relationships in high-suicide-risk individuals are related to alterations in Pavlovian behavioral biases and neural responses evoked by social stimuli. To achieve these aims, we propose to extend the follow-up of the current cohort and expand it with 80 newly recruited attempters and 60 ideators. Our study of social decision-making will employ a case-control design (including depressed individuals with no history of suicide attempt or ideation and non-psychiatric controls) to detect effects beyond those by conferred by depression and suicide ideation, and to minimize confounders. We will use a decision neuroscience framework, combining model-based imaging with multilevel clinical, behavioral, and cognitive assessments. We have established procedures to conduct this research in a safe, ethical manner. The investigative team contributes complementary expertise in suicidal behavior and neurocognitive processes (Szanto), in Pavlovian and instrumental reward learning and model-based imaging (Dombrovski, Hallquist), social decision-making (Crockett), analysis of neural and longitudinal data (Galfalvy), decision neuroscience and experimental design (Clark), neuropsychology of geriatric depression (Butters).

摘要 这是一项关于晚年自杀的纵向研究的竞争性更新。我们的最终目标是 理解老年自杀行为背后的决策过程。为了实现这一目标，我们有 招募了一组老年抑郁症高危人群（包括173名有自杀企图的患者和82名有严重自杀倾向的患者）。 自杀意念）与前瞻性确定的高自杀行为率。AIM 1.到目前为止，我们已经证明， 一方面，决策过程改变和认知控制缺陷之间存在强有力的关联， 另一方面，有自杀行为史，这与这些损伤破坏搜索的概念一致。 有建设性的选择自杀。作为关键的下一步，我们将前瞻性地确认这些关联 通过预测自杀未遂事件和自杀死亡。我们预测，决策指数将有 在解释了最近的自杀意念后的预测能力。确定最有用的事件预测因子 自杀行为，我们还将开发一个基于广泛的潜在风险的简约预测模型 因素AIM 2.迄今为止，我们的研究主要集中在非社会背景下的决策。但不少 自杀的诱因和阻吓因素植根于社会关系。在自杀危机中，人们往往无法 想想他们的自杀会给周围的人带来多大的灾难。正常年龄相关事件 残疾或退休等社会地位可能会在晚年引发自杀行为- 依赖的方式。探讨社会损失导致灾难性决策的潜在机制 优势，我们提出了一个社会决策的研究，涉及失去状态的操纵。此外，本发明还提供了一种方法， 我们建议测试高自杀风险个体的社会关系的钝化动机效应是否 与巴甫洛夫行为偏差和社会刺激诱发的神经反应的改变有关。实现 为了实现这些目标，我们建议延长目前队列的随访，并增加80名新招募的人员 设计师和60个创意者。我们对社会决策的研究将采用病例对照设计（包括 无自杀企图或意念史的抑郁个体和非精神病对照）检测效应 超越抑郁症和自杀意念所赋予的，并尽量减少混杂因素。我们将使用一个 决策神经科学框架，结合基于模型的成像与多层次的临床，行为， 认知评估我们已经建立了程序，以安全，道德的方式进行这项研究。 调查小组在自杀行为和神经认知过程方面提供补充专业知识 （Szanto），在巴甫洛夫和工具奖励学习和基于模型的成像（Dombrovski，Hallquist）， 社会决策（克罗克特），神经和纵向数据分析（Galfalvy），决策神经科学和 实验设计（Clark），老年抑郁症的神经心理学（Butters）。