Stress Responses as Prospective Predictors of Girls' Suicidality and Self-Injury

说明(申请人提供)：尤其是在女孩中，青春期的过渡与自杀意念和几种形式的自我伤害有关，包括非自杀自残(NSSI；即自残)、自杀姿势、威胁和企图。这项研究提出并将测试一个理论模型，该模型表明，对社会应激源的生物和认知反应解释了精神病态(即抑郁)和自我伤害(即中介)之间的联系，压力反应(即适度)之间的特定交互作用将有助于识别哪些患有精神病态的女孩最有可能纵向上从事自我伤害。认知和生物应激反应的具体组合被提出，以唯一地识别不同类型的自我伤害/自杀(即，NSSI与自杀意念)的风险。此外，这项研究将检验自我伤害结构的轨迹和它们之间的联系，解决过去工作的几个局限性。因此，这项研究的目的涉及PA#07-079《关于减少和预防自杀的研究》中概述的几个目标，以及NIMH战略计划(NIMH，2008)和NAMHC关于变革性神经发育研究的工作组报告(NAMHC，2008)阐述的许多目标。这项研究将使用一种创新的、基于实验室的方法范式来检验认知(即归因、社会问题解决)和生物(即神经内分泌、心血管)对体内社会应激源的反应。参与者将包括来自门诊和住院临床转诊样本的250名女性青少年。数据将从多个信息者(青少年、父母)和多个来源(观察法、结构化访谈、问卷调查、生物测试)收集。预计在实验室中观察到的压力反应将与在随访期间测量的实际社会压力的经验相互作用，以预测18个月间隔内的自我伤害轨迹。换句话说，这项研究将解决长期存在但未被充分探索的问题，即为什么以及如何将心理症状和/或压力体验与自我伤害行为联系起来。

DESCRIPTION (provided by applicant): Especially among girls, the adolescent transition is associated with dramatic increases in the prevalence of suicidal ideation, and several forms of self-injury, including non-suicidal self-injury (NSSI; i.e., self-mutilation), suicidal gestures, threats, and attempts. This study proposes, and will test a theoretical model suggesting that biological and cognitive responses to social stressors explain the association between psychopathology (i.e., depression) and self-injury (i.e., mediation) and that specific interactions between stress responses (i.e., moderation) will help identify which girls with psychopathology are most likely to engage in self-injury longitudinally. Specific combinations of cognitive and biological stress responses are proposed to uniquely identify risks for different types of self-injury/suicidality (i.e., NSSI vs. suicidal ideation). Moreover, this study will examine trajectories of, and associations among self-injury constructs, addressing several limitations of past work. The aims of this research thus address several of the goals outlined in PA # 07-079, Research on the Reduction and Prevention of Suicidality as well as many of the goals articulated the NIMH Strategic Plan (NIMH, 2008) and the NAMHC Workgroup report on Transformative Neurodevelopmental Research (NAMHC, 2008). This study will use an innovative, lab-based methodological paradigm to examine cognitive (i.e., attributions, social problem solving) and biological (i.e., neuroendocrine, cardiovascular) responses to an in vivo social stressor. Participants will include 250 female adolescents from both outpatient and inpatient clinically-referred samples. Data will be collected from multiple informants (adolescents, parents) and multiple sources (observational methods, structured interviews, questionnaires, biological assays). It is expected that observed stress responses in the lab will interact with the experience of actual social stress measured during follow-up to predict self-injury trajectories over an 18 month interval. In other words, this study will address long-standing, but under-explored questions regarding why and how psychological symptoms, and/or the experience of stress, are associated with self-injurious behaviors.