Multimodal Assessment of Near-term Risk Processes for Suicide Ideation and Behavior

摘要/项目摘要 18-25岁年轻人的自杀率已升至30多年来的最高水平 我们准确预测自杀企图的能力仍然受限于远端、静态的危险因素。有一件急事 需要研究确定在不久的将来评估谁最有自杀风险的方法，与 国家行动联盟优先研究议程的抱负目标3。因此，最重要的是 来自早期调查人员的这份R01的目标是提高我们识别特定近期、 动态的人内过程，可以预测脆弱个体自杀风险的急剧增加。 与从属关系和依恋有关的社会过程(例如，社会拒绝或排斥)以及痛苦和 挑衅性事件(PPE；例如，暴力创伤和自伤)是众所周知的自杀远端风险因素。 然而，动态认知-情感和生物反应对拒绝经历的作用 人们对任何个体近期自杀风险的预测都知之甚少。此外，目前还不知道 排斥相关过程对近期自杀风险的影响可能随着远端风险因素的不同而不同 比如接触个人防护装备。目前的应用概述了一项多方法密集的纵向研究 检查对拒绝的动态情感和生理反应作为临时性的近期危险因素 自杀想法和行为(STB)在几小时到几天、几周和几个月的过程中的波动。我们 还将研究个人防护用品的暴露，作为一种调节因素，放大个人对社会拒绝的内部反应， 从而进一步增加自杀风险。参与者将包括150个诊断不同的临床样本 在过去4个月内患有临床显著性传播疾病的年轻成年男性和女性(年龄18至35岁)。多式联运 基线评估将包括为期21天的随机和基于事件的生态瞬时评估 (EMA)方案；带有心理生理测量、自我报告和评估的实验室范例 与自杀相关的内隐认知；以及采用时间线追踪(TLFB)方法的访谈。评估时间： 在12个月的过程中，4个月的间隔将包括重复的实验室任务，生理和 隐性评估、自我报告和TLFB访谈，以评估对拒绝的反应、PPE和 随着时间的推移，STB。拟议的项目有三个具体目标：(1)审查多式联运措施-- 个体对拒绝的情感和生理反应作为近期的、前瞻性的预测因子 人在STB中随时间的波动；(2)检查人与人之间接触PPE-远端调节剂 个人内部过程导致个人层面的STB短期增加；以及(3)应用机器 识别多个时变的人内过程和静态过程的组合的学习技术 随着时间的推移，最能预测自杀风险的人与人之间的差异。这项研究的结果将导致 自杀风险评估、新干预点的确定和研究进展 采取个性化干预措施，防止易受伤害的人企图自杀。

Abstract/Project Summary The suicide rate among young adults aged 18-25 has risen to the highest level in more than 30 years, yet our ability to accurately predict suicide attempts remains limited to distal, static risk factors. There is an urgent need for research to identify ways to assess who is most at risk for suicide in the near future, consistent with Aspirational Goal 3 of the National Action Alliance’s Prioritized Research Agenda. Accordingly, the overarching goal of this R01 from an Early Stage Investigator is to improve our ability to identify specific near-term, dynamic within-person processes that predict acute increases in a vulnerable individual’s risk for suicide. Social processes related to affiliation and attachment (e.g., social rejection or exclusion), as well as painful and provocative events (PPE; e.g., violent trauma and self-injury), are well-known distal risk factors for suicide. However, the role of dynamic cognitive-affective and biological responses to experiences of rejection for predicting near-term suicide risk in any individual is poorly understood. In addition, it is not known how the influence of rejection-related processes on near-term suicide risk may vary as a function of distal risk factors such as exposure to PPE. The current application outlines a multimethod intensive longitudinal study to examine dynamic affective and physiological responses to rejection as near-term risk factors for temporal fluctuations in suicidal thoughts and behaviors (STB) over the course of hours to days, weeks, and months. We will also examine exposure to PPE as a moderator that amplifies intraindividual reactivity to social rejection, thereby further increasing suicide risk. Participants will include a diagnostically diverse clinical sample of 150 young adult men and women (ages 18 to 35) with clinically significant STB in the past 4 months. Multimodal assessments at baseline will include a 21-day random and event-based ecological momentary assessment (EMA) protocol; laboratory paradigms with psychophysiological measures, self-reports, and assessment of implicit suicide-related cognition; and interviews using timeline follow-back (TLFB) methods. Assessments at 4-month intervals over the course of 12 months will include repeated laboratory tasks, physiological and implicit assessments, self-reports, and TLFB interviews to assess changes in responses to rejection, PPE, and STB over time. The proposed project has three specific aims: (1) Examine multimodal measures of within- individual affective and physiological responses to rejection as near-term, prospective predictors of within- person fluctuations in STB over time; (2) Examine exposure to PPE as between-persons distal moderators of within-person processes leading to near-term increases in STB at the individual level; and (3) Apply machine learning techniques to identify combinations of multiple time-varying within-person processes and static between-person differences that are most predictive of suicide risk over time. Results of this study will lead to advances in suicide risk assessment, identification of novel points of intervention, and development of personalized interventions to prevent suicide attempts among vulnerable individuals.