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

描述（由申请人提供）：特别是在女孩中，青春期的转变与自杀意念和几种自伤形式的急剧增加有关，包括非自杀性自伤（自伤，即自残），自杀姿态，威胁和企图。本研究提出并将测试一个理论模型，该模型表明，对社会压力源的生物学和认知反应解释了精神病理（即抑郁）和自伤（即调解）之间的联系，以及压力反应（即适度）之间的具体相互作用将有助于确定哪些精神病理女孩最有可能长期从事自伤。提出了认知和生物应激反应的特定组合，以独特地识别不同类型的自伤/自杀（即自伤与自杀意念）的风险。此外，本研究将研究自伤结构的发展轨迹和关联，解决过去工作的几个局限性。因此，这项研究的目的是解决PA # 07-079中概述的几个目标，减少和预防自杀的研究，以及NIMH战略计划（NIMH, 2008）和NAMHC工作小组关于转化神经发育研究的报告（NAMHC, 2008）中阐明的许多目标。本研究将使用一种创新的、基于实验室的方法范式来检验对体内社会压力源的认知（即归因、社会问题解决）和生物（即神经内分泌、心血管）反应。参与者将包括250名女性青少年门诊和住院的临床参考样本。数据将从多个举报人（青少年、父母）和多个来源（观察方法、结构化访谈、问卷调查、生物分析）收集。预计在实验室中观察到的应激反应将与随访期间测量的实际社会应激经验相互作用，以预测18个月间隔内的自伤轨迹。换句话说，这项研究将解决长期存在但未被探索的问题，即心理症状和/或压力经历为何以及如何与自残行为相关。

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.