Adolescent Girls’ Risk for Suicide Across the Menstrual Cycle: Examining Stress and Negative Valence Systems Longitudinally

青春期女孩在整个月经周期的自杀风险：纵向检查压力和负价系统

• 批准号: 10350648
• 负责人: Tory Anne Eisenlohr-Moul
• 金额: $ 71.65万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10350648
• 关键词: 12 year old; Accidents; Acute; Adolescence; Adolescent; Adult; Affective; Age; Anger; Anxiety; Award; Behavioral; Biological Assay; Biological Markers; Cause of Death; Characteristics; Clinical; Country; Data; Development; Diagnosis; Diagnostic Procedure; Distal; Feeling; Feeling suicidal; Female; Female Adolescents; Funding; Future; Genomics; Hormones; Hydrocortisone; Individual Differences; Interruption; Laboratories; Link; Literature; Measures; Mediating; Mediator; Menarche; Menstrual cycle; Mental Depression; Mental disorders; Molecular; Mood Disorders; Moods; Negative Valence; Neurosciences; Ovarian hormone; Participant; Persons; Phase; Physiological; Procedures; Process; Psychopathology; Recurrence; Reporting; Research; Research Domain Criteria; Research Personnel; Risk; Risk Behaviors; Risk Factors; Sampling; Science; Severities; Shapes; Standardization; Stress; Suicide; Suicide attempt; Surveys; System; Testing; Time; United States National Institutes of Health; Visit; Woman; Work; Youth; aged; biological adaptation to stress; boys; depressive symptoms; design; diaries; experience; follow-up; girls; high risk; hormone sensitivity; ideation; innovation; molecular marker; mortality; negative affect; perimenstrual; predicting response; programs; proliferative phase Menstrual cycle; prospective; psychological symptom; recruit; reproductive; reproductive hormone; response; social; social adversity; social stress; stress reactivity; stressor; suicidal adolescent; suicidal behavior; suicidal risk; suicide rate; theories; virtual

Project Summary/Abstract Suicide is the second leading cause of death (behind accidents) among those ages 10-34 years in the US and is the cause of mortality most strongly linked to mental illness. Starting at approximately age 12 years, the rate of suicidal thoughts and behaviors (STBs) increases dramatically, especially among girls, who experience STBs at twice the rate for boys. These pronounced increases for adolescents and for girls have been well-documented for decades and are seen in virtually every country/culture around the world, yet, there is no firm understanding of why they exist. Moreover, very little is known about when risk is highest. The proposed research extends our team’s prior work, funded by two prior R01 awards, examining adolescent girls’ stress responses as prospective predictors of STB trajectories, and a K99/R00 award revealing that changes in reproductive hormones across the menstrual cycle produce specific periods of high STB risk (particularly during the peri-menstrual phase) among adult women. Specifically, we hypothesize that girls will report higher occurrence and severity of STBs on days in the peri-menstrual phase than on days in other cycle phases (mid-follicular, ovulatory, mid-luteal), that these increases will be mediated by daily changes in negative affect and stress-reactivity during the peri- menstrual phase, and that girls with greater cyclical hormone sensitivity are at greater long-term risk of STBs, particularly during times when interpersonal stress is elevated. We propose to test these hypotheses in a sample of 200 clinically-referred girls ages 12-17 years who are at least one year post-menarche. The design begins with 70 days (two cycles) of daily surveys to assess negative affect and STBs. In addition, girls will complete two counterbalanced laboratory visits (at high risk peri-menstrual and low risk mid-follicular phases) during which we will evaluate their affective and physiological (autonomic, cortisol, genomic) responses to a standardized laboratory stressor. Next, girls will complete weekly surveys measuring cycle phase, interpersonal stress, negative affect, and STBs through one year of follow up. The intensive two-month baseline phase allows us to examine how the menstrual cycle shapes daily affective and physiological risk for STBs and lets us diagnose each girl’s degree of hormone sensitivity. These baseline individual differences in hormone sensitivity then can be examined as a predictor of STBs across the follow-up year of assessments, particularly during periods of elevated social stress. This powerful design will clarify whether cyclical changes in daily STBs (Aim 1) are mediated by affective and physiological STB risk factors, such as negative affect (Aim 2a; measured via daily surveys) and social stress reactivity (Aim 2b; measured via lab-based behavioral, physiological, and molecular biomarker assays), while also acknowledging critical moderation by both individual differences in hormone sensitivity (i.e., not all girls will have severe cyclical mood changes) and time-varying interpersonal stress (Aim 3). This innovative study will address several long-standing questions in the literature, including why girls are at increased risk, when girls may be most at risk, and which girls are at highest risk for future STBs.

项目摘要/摘要 自杀是美国10-34岁人群的第二大死因(仅次于事故)， 是与精神疾病联系最密切的死亡原因。从大约12岁开始，这个比率 自杀想法和行为(STB)的发生率急剧上升，特别是在经历过STB的女孩中 是男孩的两倍。对于青少年和女孩来说，这些显著的增长是有据可查的。 几十年来，几乎在世界上每个国家/文化中都能看到这种现象，但目前还没有确切的理解 他们为什么会存在。此外，人们对何时风险最高知之甚少。拟议的研究扩展了我们的 该团队之前的工作，由之前的两个R01奖资助，将青春期女孩的压力反应作为预期的 STB轨迹的预测者，以及K99/R00奖揭示了生殖激素的变化 月经周期会产生特定的STB高危时期(尤其是在经期)。 在成年女性中。具体地说，我们假设女孩报告的性传播疾病的发生率和严重性更高 在月经期的天数多于其他周期的天数(卵泡中期、排卵期、黄体中期)， 这些增加将通过围产期负性情绪和应激反应性的日常变化来调节。 月经期，周期激素敏感性较高的女孩患性传播疾病的长期风险更大， 尤其是在人际关系紧张的时候。我们建议在样本中检验这些假设 在200名年龄在12-17岁、月经初潮后至少一年的临床转诊女孩中。设计开始了 每天进行70天(两个周期)的调查，以评估负面影响和性传播疾病。此外，女孩们还将完成两项 平衡的实验室访问(在高风险的经期和低风险的卵泡中期)，在此期间我们 将评估他们的情感和生理(自主神经、皮质醇、基因组)对标准化的反应 实验室应激源。接下来，女孩将完成每周一次的调查，测量周期阶段，人际压力， 负性情绪和性传播疾病通过一年的随访。密集的两个月基线阶段使我们能够 检查月经周期如何影响性传播疾病的日常情感和生理风险，并让我们诊断 每个女孩对荷尔蒙的敏感程度。这些激素敏感性的基线个体差异可以 在后续评估年度，特别是在#年期间，将其作为STB的预测指标进行审查 社会压力上升。这一强大的设计将澄清每日STB(目标1)的周期性变化是否 由情感和生理的STB风险因素调节，如负面情绪(目标2a；通过每日测量 调查)和社会压力反应性(目标2b；通过基于实验室的行为、生理和分子测量 生物标记物分析)，同时也承认由于两种激素的个体差异而产生的临界调节 敏感性(即，不是所有女孩都会有严重的周期性情绪变化)和时变的人际压力(目标 3)。这项创新的研究将解决文献中的几个长期存在的问题，包括为什么女孩在 增加风险，何时女孩可能面临最大风险，以及哪些女孩未来感染性传播疾病的风险最高。