Dynamic Regulatory Processes in the Transition from Suicidal Ideation to Action: The Roles of Cognitive Control, Emotion-Related Impulsivity, and Sleep in the Context of Negative Affective Experiences

项目摘要 很少有NIMH资助的研究考察自杀意念的短期、个人内部变化的贡献者 和自杀行为的几率。我们建议使用多模式评估(自我报告、行为、行动记录) 以捕捉与自杀风险相关的几个RDoC域中的变化。在从思想到行动的框架中，我们 区分自杀念头的急性危险因素和导致自杀念头转变的危险因素 思维对行为的影响。我们将在一个样本中使用28天的密集纵向设计来检验我们的理论模型。 有自杀倾向的成年人离开住院行为保健，这是一个自杀风险特别高的人群。 目标1：检验一组跨理论的危险因素作为自杀倾向个人内部变化的近似性预测因素 思想。使用生态瞬时评估，我们将收集七个假设的重复测量 构思风险因素，以及构思的维度测量，以模拟 情感风险因素和随后的思维。我们预计，每个情感风险因素都将显示出积极的 与随后自杀意念的增加有关，并且这些危险因素将在日常生活中同时发生 因此，它们最好被概念化为捕捉情感痛苦(心理痛苦)的单一潜在结构。 目的：检验自我报告和抑制性控制的行为措施是自杀行为的危险因素。我们 预计那些在基线时报告与情绪相关的冲动更大的参与者，以及那些表现出受损的参与者 在使用负价刺激的行为任务中，反应抑制会有更高的自杀企图几率 过多的跟进。在生态瞬间使用一种新的移动适应抑制控制任务 在评估期内，我们预计人内抑制性控制的减少将先于人内 在有自杀想法的个体中，自杀企图的可能性增加。 目的3：评估客观测量的睡眠时间作为自杀念头和自杀意念的近端风险因素 自杀行为。使用手腕佩戴的动作记录仪，我们将检查睡眠时间有多短，与 参与者的平均睡眠与第二天的思维和尝试有关。我们预计较短的睡眠时间将 预测个人自杀念头的增加，以及自杀企图的可能性增加， 控制自杀意念。最后，我们将测试一个探索性假设，即睡眠自杀企图 这种联系的解释是，在负面情绪的背景下，与睡眠相关的抑制性控制减少。 这项研究的发现将阐明可修改的情感、认知和生理目标， 防止自杀的流动干预措施。

Project Abstract Few NIMH-funded studies have examined contributors to short-term, within-person changes in suicidal ideation and odds of suicidal behavior. We propose to use multi-modal assessments (self-report, behavior, actigraphy) to capture changes in several RDoC domains relevant to suicide risk. In an ideation-to-action framework, we differentiate acute risk factors for suicidal thoughts from those that contribute to the transition from suicidal ideation to behavior. We will test our theoretical model using a 28-day intensive longitudinal design in a sample of suicidal adults leaving inpatient behavioral health care, a population at particularly high risk for suicide. Aim 1: Examine a set of transtheoretical risk factors as proximal predictors of within-person changes in suicidal thoughts. Using ecological momentary assessment, we will gather repeated measures of seven hypothesized ideation risk factors, as well as a dimensional measure of ideation, to model lagged relationships between affective risk factors and subsequent ideation. We expect that each affective risk factor will show a positive association with subsequent increases in suicidal ideation, and that these risk factors will co-occur in daily life such that they are best conceptualized as a single latent construct capturing emotional suffering (psychache). Aim 2: Test self-report and behavioral measures of inhibitory control as risk factors for suicidal behavior. We expect that participants who, at baseline, report greater emotion-related impulsivity, and who show impaired response inhibition in a behavioral task using negative valence stimuli, will have higher odds of suicide attempt over follow-up. Using a novel mobile adaptation of an inhibitory control task during the ecological momentary assessment period, we expect that within-person decrements in inhibitory control will precede within-person increases in likelihood of suicide attempt among individuals thinking of suicide. Aim 3: Evaluate objectively measured sleep duration as a proximal risk factor for both suicidal ideation and suicidal behavior. Using wrist-worn actigraphy devices, we will examine how short sleep duration, compared to participants’ average sleep, relates to next-day ideation and attempts. We expect that short sleep duration will predict within-person increases in suicidal thoughts, as well as increased likelihood of suicide attempts, controlling for suicidal ideation. Finally, we will test an exploratory hypothesis, that the sleep-suicide attempt association is explained by sleep-related decreases in inhibitory control in the context of negative affect. Findings from this study will elucidate modifiable affective, cognitive, and physiological targets for just-in-time, mobile interventions to prevent suicide.