Suicidal Behavior: Aggression Subtypes, Childhood Adversity and Stress Response

攻击性、童年时期的逆境和对压力的反应都是导致心脏病风险的关键因素 自杀行为。然而，这些变量之间的关系及其对 自杀行为没有得到很好的理解，部分原因是措施上的限制。从概念上讲，可能存在 是每个维度或子类型以不同方式导致自杀风险的多个维度或子类型 项目是表征参与者表现出攻击行为的程度和性质，将其与 对儿童逆境类型的详细评估以及对以下情况的心理生物反应 应激，并最终将所有这些与自杀未遂者和非自杀未遂者的自杀行为联系起来。 严重抑郁障碍、自杀患者的高危后代和健康志愿者。攻击性 将通过面谈、自我报告和行为测量(扣分攻击性)进行评估 范例)来描述行为的反应性与主动性。而反作用力的攻击- 以对情景挑衅和情绪波动的敏锐反应为特征-被认为是 自杀行为的很大一部分是主动攻击--更刻意的行为，更少公开的行为 情绪反应--系统研究较少，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，这是一种区分 在身体虐待、性虐待和情感虐待/忽视中。我们的初步数据显示 过去虐待对自杀行为的影响是通过攻击性来调节的。压力反应将通过以下方式进行评估 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 对这种应激源的皮质醇反应增强在那些高度冲动攻击性的人中很明显，这组人 并不包括所有自杀未遂者。因此，有一种亚类型的尝试者出现得更多 对这些情景压力源敏感，但另一种亚型--目前特征不佳--不敏感。 最终，这个项目将对确定自杀的替代途径做出重大贡献 行为，具有潜在不同的潜在神经生物学机制。与来自以下项目的数据相结合 5-羟色胺转运体的PET受体研究(项目3)和功能磁共振成像 情绪调节研究(项目4)，这些研究将确定这些生物之间的关系 以及行为措施，可以提供更紧密地根据个人需求定制的干预目标。

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.