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经上升到30多年来的最高水平， 我们准确预测自杀企图的能力仍然局限于远端、静态的风险因素。目前迫切 需要进行研究，以确定如何评估谁是最有可能在不久的将来自杀，符合 国家行动联盟优先研究议程的理想目标3。因此，总体而言， 来自早期研究者的R 01的目标是提高我们识别特定近期， 预测脆弱个体自杀风险急剧增加的动态人内过程。 与归属和依恋有关的社会过程（例如，社会排斥或排斥），以及痛苦和 挑衅事件（PPE;例如，暴力创伤和自伤），是众所周知的自杀的远端风险因素。 然而，动态认知情感和生物反应的作用，拒绝的经验， 预测任何个体的近期自杀风险都知之甚少。此外，尚不清楚 拒绝相关过程对近期自杀风险的影响可能因远端风险因素而异 例如暴露于PPE。本申请概述了一项多方法密集纵向研究， 检查对拒绝的动态情感和生理反应作为暂时性排斥的近期风险因素， 自杀想法和行为（STB）在数小时至数天，数周和数月的过程中的波动。我们 还将研究暴露于PPE作为一种调节剂，放大了个体对社会排斥的反应， 从而进一步增加自杀风险。参与者将包括150名诊断多样化的临床样本 在过去4个月内患有临床显著STB的年轻成年男性和女性（年龄18至35岁）。多式 基线评估将包括21天的随机和基于事件的生态瞬时评估 (EMA)方案;实验室范式与心理生理学措施，自我报告，和评估 内隐自杀相关认知;以及使用时间轴追踪（TLFB）方法的访谈。摊款 4-在12个月的过程中，每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、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， 个人情感和生理反应拒绝作为近期，前瞻性预测内- 人STB随时间的波动;（2）检查PPE暴露，作为人与人之间的远端调节器， 个人内部流程导致个人层面STB的短期增加;以及（3）应用机器 学习技术，以识别多个随时间变化的人内过程和静态 随着时间的推移，人与人之间的差异最能预测自杀风险。这项研究的结果将导致 自杀风险评估、新干预点的确定以及 个性化干预措施，以防止弱势群体的自杀企图。

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.