Life Stressors, Impulsivity, and Adolescent Suicidal Behavior

生活压力、冲动和青少年自杀行为

• 批准号: 8644370
• 负责人: Richard T Liu
• 金额: $ 40.95万
• 依托单位: EMMA PENDLETON BRADLEY HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-02-01 至 2019-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8644370
• 关键词: 16 year old; Accounting; Address; Admission activity; Adolescent; Behavior; Behavior Therapy; Behavioral; Biological Markers; Cause of Death; Characteristics; Clinical; Clinical effectiveness; Cognitive; Coping Skills; Dimensions; Elements; Event; Fright; Functional disorder; Future; Generations; Goals; Healthy People 2020; Hospitals; Impulsivity; Individual; Inpatients; Intervention; Interview; Knowledge; Laboratories; Life; Life Stress; Link; Literature; Longitudinal Studies; Measures; Mediating; Mental Depression; Methodology; Methods; Nature; Neurocognitive; Pain; Pain Threshold; Pathway interactions; Patient Self-Report; Prevention strategy; Process; Psychopathology; Public Health; Recording of previous events; Recurrence; Relative (related person); Reliance; Research; Research Personnel; Rewards; Risk; Risk Factors; Sampling; Self-Injurious Behavior; Strategic Planning; Stress; Suicide; Suicide attempt; Suicide prevention; Testing; Theoretical model; Time; Youth; base; behavior influence; clinically significant; design; experience; high risk; innovation; intervention effect; intervention program; neurobehavioral; non-suicidal self injury; peer; programs; public health relevance; reducing suicide; response; stressor; suicidal; suicidal behavior; suicidal risk; suicide model; theories

Abstract Suicide is the third leading cause of death among youth. Although considerable progress has been made in recent decades in identifying risk factors for suicidal behaviors, improvements in clinical intervention programs have been comparatively modest. These modest gains in clinical effectiveness reflect, in part, the fact that, although we know many of the risk factors for suicidal behaviors, we know little about how they confer heightened risk. Indeed, a history of self-injurious behavior (i.e., suicide attempts and non-suicidal self-injury [NSSI]) has been consistently found to be the strongest predictor of future suicide attempts. Yet, studies on the pathways and processes explaining the link between past and future suicidal behaviors have been lacking. Although both life stressors and impulsivity have been widely studied in relation to suicidal behaviors, and feature prominently in several theoretical models of suicidal behaviors, no studies have examined how they interrelate to predict future suicidal behaviors. This New Investigator application will address these critical gaps in current knowledge by integrating and extending findings from the separate lines of research on these risk factors for suicidal behavior. Specifically, it will examine how life stressors, different neurocognitive/neurobehavioral dimensions of impulsivity (encompassing two RDoC constructs, "reward valuation" and "response selection, inhibition or suppression"), and loss-related experiences, consistent with the RDoC construct of loss, may explain how past suicide attempts increase risk for future recurrences in a multiwave longitudinal study with a sample of 150 adolescent inpatients. Adolescents 14-16 years old will complete a state-of-the-art life stress interview and a multi-method and multi-dimensional assessment of impulsivity at the time of an inpatient psychiatric admission, and at 3-months, 6-months, 12-months, and 18- months post-hospital discharge. The central hypothesis is that adolescents with a history of suicide attempts will (a) experience greater dependent stressors (i.e., those that are influenced by their own behaviors), and (b) this increased rate of dependent stressors, in turn, increases their risk for future suicide attempts. We also hypothesize that behavioral impulsivity will similarly predict future suicide attempts by generating greater dependent stressors. We will also examine whether NSSI predicts dependent stressors, which in turn predicts future suicide attempts. Findings from this study have the potential to advance clinical intervention strategies. The types of stressors found to be most relevant to suicide risk may speak to the promise of different clinical approaches (e.g., behavioral modification in the case of dependent stressors and coping skills for independent stressors). The public health relevance of this application is evident as it addresses Healthy People 2020 Objective MHMD HP 2020- 2: "Reduce suicide attempts by adolescents". This application is also consistent with NIMH's Strategic Plan, which highlights the need for research on biomarkers and behavioral indicators related to psychopathology, and for research based on dimensions of observable behavior and neurobehavioral methodologies.

摘要 自杀是年轻人的第三大死因。尽管在以下方面取得了相当大的进展 近几十年来，在确定自杀行为的危险因素方面，改进了临床干预计划 一直比较谦虚。临床疗效的这些适度增长在一定程度上反映了这样一个事实， 虽然我们知道自杀行为的许多危险因素，但我们对它们是如何产生的知之甚少。 高风险。事实上，有自我伤害行为的历史(即自杀未遂和非自杀性自我伤害 [NSSI])一直被发现是未来自杀企图的最强预测者。然而，对这一问题的研究 解释过去和未来自杀行为之间联系的途径和过程一直缺乏。 尽管生活压力源和冲动与自杀行为的关系已经被广泛研究，而且 在自杀行为的几个理论模型中都有突出的特征，但还没有研究检验它们是如何 与预测未来的自杀行为相互关联。这款新的Investigator应用程序将解决这些关键差距 通过整合和扩展关于这些风险的不同研究方向的发现，在当前知识中 自杀行为的因素。具体地说，它将研究生活压力源如何不同 冲动性的神经认知/神经行为维度(包括两个RDoC结构，“奖励” 估值“和”反应选择、抑制或抑制“)，以及与损失有关的经验，与 RDoC的损失结构，可以解释过去的自杀企图如何增加未来复发的风险 对150例青少年住院患者进行多波纵向研究。14-16岁的青少年会 完成最先进的生活压力访谈和多方法、多维度的评估 住院时的冲动，以及在3个月、6个月、12个月和18个月时- 出院后几个月。中心假设是有自杀未遂历史的青少年 会不会(A)经历更大的依赖压力源(即那些受自身行为影响的压力源)，以及(B) 这种依赖压力源的增加，反过来又增加了他们未来自杀企图的风险。我们也 假设行为冲动将类似地通过产生更大的 依赖性压力源。我们还将研究NSSI是否预测依赖应激源，而依赖应激源反过来又预测 未来的自杀未遂。这项研究的发现有可能推进临床干预策略。 被发现与自杀风险最相关的压力源类型可能代表着不同的临床前景 方法(例如，在依赖应激源的情况下进行行为矫正，以及在独立情况下的应对技能 压力源)。此应用程序的公共卫生相关性很明显，因为它针对2020年的健康人 目的MHMD HP 2020-2：“减少青少年自杀企图”。这个应用程序也是一致的 NIMH的战略计划强调了对生物标志物和行为指标进行研究的必要性 与精神病理学有关，并基于可观察到的行为和 神经行为方法论。