Suicidal Behavior: Aggression Subtypes, Childhood Adversity and Stress Response

攻击性，童年逆境和对压力的反应都是导致风险的关键因素。 自杀行为然而，这些变量之间的关系及其对 自杀行为还没有得到很好的理解，部分原因是措施的局限性。从概念上讲， 是多个维度或亚型的每一个，有助于自杀风险以不同的方式， 项目是表征参与者表现出的攻击性行为的程度和性质，将其与 对儿童期逆境类型的详细评估，以及对环境、心理生物学反应的详细评估， 压力，并最终将所有这些与自杀者和非自杀者的自杀行为联系起来， 重度抑郁症、自杀个体的高风险后代和健康志愿者。攻击性 将通过访谈、自我报告和行为测量（减点攻击）进行评估 范式）来表征行为的反应性与主动性。当反应性攻击- 其特点是对情境刺激和情绪波动的急性反应-被认为是 自杀行为的相当一部分，主动攻击-更多的故意行为， 情绪反应-较少系统研究，但也与自杀行为有关 童年逆境将通过童年创伤问卷进行评估，这是一项区分 身体虐待、性虐待和情感虐待/忽视。我们的初步数据表明， 过去的虐待对自杀行为的影响是由攻击介导的。将通过以下方式评估应激反应： 特里尔社会压力测试的行为和皮质醇反应。我们的初步数据显示， 对这种压力源的皮质醇反应增强在那些具有高冲动攻击性的人中是明显的， 并不包括所有的自杀者。因此，有一个亚型的hepatitis谁出现更多 对这些情境压力敏感，但另一种亚型-目前特征不佳-则不敏感。 最终，这个项目将对描述自杀的替代途径做出重大贡献。 行为，具有潜在的不同的潜在神经生物学机制。结合来自 5-羟色胺转运体的PET受体研究（项目3）和功能性磁共振成像 情绪调节的研究（项目4），这些研究将确定这些生物之间的关系 以及行为测量，可以提供更符合个人需求的干预目标。

Aggression, childhood adversity, and the response to stress are all critical factors contributing to risk for suicidal behavior. However, the relationships among these variables and their relative contribution to suicidal behavior are not well-understood, in part, due to limitations in measures. Conceptually, there may be multiple dimensions or subtypes of each that contribute to suicide risk in different ways The goal of this project is characterize the extent and nature of aggressive behavior exhibited by participants, relate it to detailed assessments of types of childhood adversity as well as to situational, psychobiological responses to stress, and ultimately relate all of these to suicidal behavior in suicide attempters and non-attempters with major depressive disorder, high-risk offspring of suicidal individuals, and healthy volunteers. Aggressiveness will be assessed via interview, self report and a behavioral measure (Point Subtraction Aggression Paradigm) to characterize the reactive vs. proactive nature of the behavior. While Reactive Aggression - characterized by acute responses to situational provocation and emotional volatility - is thought to underlie a substantial portion of suicidal behavior, Proactive Aggression - more deliberate behaviors with less overt emotional reactivity - has been less systematically studied, but has also been related to suicidal behavior Childhood adversity will be assessed via the Childhood Trauma Questionnaire, a measure that distinguishes among physical abuse, sexual abuse, and emotional abuse/neglect. Our preliminary data indicate that the effect of past abuse on suicidal behavior is mediated by aggression. Stress response will be assessed via behavioral and Cortisol responses to the Trier Social Stress Test. Our preliminary data indicate that heightened Cortisol response to this stressor is evident in those with high impulsive aggression, a group that does not encompass all suicide attempters. Thus, there is a subtype of attempter who appears more sensitive to these situational stressors, but another subtype - currently poorly characterized - that does not. Ultimately, this project will make a major contribution toward characterizing alternative pathways to suicidal behavior, with potentially different underlying neurobiological mechanisms. In conjunction with data from PET receptor studies of the serotonin transporter (Project 3) and functional magnetic resonance imaging studies of emotional regulation (Project 4), these studies will identify relationships among these biological and behavioral measures that can provide targets for intervention more closely tailored to individual needs.