Impulsive Aggression, Neurocognition, and Suicidal Behavior in Depressed Youth

描述（由申请人提供）：重度抑郁症（MDD）是青少年自杀行为的最强有力的精神风险因素，但大多数抑郁青年从未尝试自杀，降低了MDD诊断在衡量未来自杀行为风险方面的阳性预测值。预防青少年自杀的努力将大大受益于更深入地了解抑郁青年自杀行为的前兆和途径，特别是如果这些知识有助于制定有效的风险评估和干预策略。增加抑郁青少年未来自杀企图风险的可测量因素的知识可能被证明对预防青少年自杀的努力至关重要，因为：1）帮助识别自杀风险特别高的抑郁青少年，他们至少可能需要更密切的监督和遏制; 2）确定情绪障碍本身以外的临床干预目标;及（三）协助发展评估工具及风险指标，以更有效地评估个人自杀风险，并为有自杀风险青少年的临床干预研究提供资料。来自早期研究者（ESI）的拟议R 01申请将通过检查冲动性攻击和神经认知功能在MDD青少年自杀行为发病机制中的作用来解决关键的知识缺口。核心假设是，冲动性攻击和执行功能和决策的缺陷将大大有助于未来自杀企图的模型，并为传统的评估方法增加了积极的预测价值。我们的假设是由有前途的试点工作，其中措施的冲动攻击和决策赤字急剧区分抑郁症青少年自杀未遂者从非未遂者。该设计包括横断面比较以及对300名有或没有自杀未遂史的抑郁青少年进行的前瞻性纵向研究，随后从青春期早期到中期，这是自杀行为风险最高的发展时期。这些结果将有助于NIMH的使命，通过提高我们的能力，以确定时间和可能的因果顺序的前因，以未来的自杀行为的青少年与MDD，从而制定实际的临床风险评估，干预和预防自杀行为的目标。

DESCRIPTION (provided by applicant): Major Depressive Disorder (MDD) is the most potent psychiatric risk factor for suicidal behavior in adolescents, yet most depressed youth never attempt suicide, diminishing the positive predictive value of a diagnosis of MDD in gauging the risk of future suicidal acts. Efforts to prevent youth suicide would benefit greatly from a deeper understanding of precursors and pathways to suicidal behavior in depressed youth, particularly if such knowledge informs the development of effective risk evaluation and intervention strategies. Knowledge of measurable factors that increase the risk of future suicide attempts in depressed adolescents could prove critical to efforts to prevent youth suicide by virtue of: 1) aiding in the recognition of depressed youth at especially heightened risk for suicide, who at a minimum may require closer supervision and containment; 2) identifying targets for clinical intervention beyond the mood disorder per se; and, 3) contributing to the development of assessment tools and risk markers relevant to better gauging individual suicide risk and informing clinical intervention research with youth at risk for suicide. The proposed R01 application from an early stage investigator (ESI) will address critical gaps in knowledge by examining the role of impulsive aggression and neurocognitive functioning in the etiopathogenesis of suicidal behavior in adolescents with MDD. The central hypothesis is that impulsive aggression and deficits in executive function and decision making will contribute substantially to a model of future suicide attempts and add positive predictive value to traditional assessment approaches. Our hypothesis is informed by promising pilot work in which measures of impulsive aggression and decision making deficits sharply distinguished depressed adolescent suicide attempters from non-attempters. The design includes cross-sectional comparisons as well as a prospective longitudinal study of 300 depressed youth with and without a prior history of suicide attempt, followed from early to middle adolescence, the developmental period of highest risk for suicidal behavior. These results will contribute to the mission of the NIMH by improving our capacity to identify the temporal and likely causal sequence of antecedents to future suicidal acts in youth with MDD, thus framing targets for practical clinical risk assessment, intervention, and the prevention of suicidal behavior.