Biomarkers, social, and affective predictors of suicidal thoughts and behaviors in adolescents

描述（由申请人提供）：三分之一到一半的精神病住院青年再次入院，出院后15-30天再次入院的风险最高，超过80%的人在三个月内再次入院。拟议的研究涉及在体内的自然现象与自杀风险出院后的青少年使用生态的方法和设备，允许声学捕获个人的社会环境和自我报告的经验影响。我们认为，社会背景和经验丰富的影响是相互加强的，一个反应式的风格，涉及密切耦合的压力社会 背景（孤立，冲突或高情感互动）与情感反应（快速变化，强烈的影响，缓慢恢复到基线）增加自杀想法和行为的风险。我们还研究了童年虐待和表观遗传标记作为出院后反应的预测因素。200名因自杀想法和行为住院的青年将在精神病出院后使用生态学方法和设备前瞻性地随访3周;自杀想法和行为将在6个月时重新评估。本研究通过纳入情感反应性生物标志物（用于评估DNA/DNAm/表达的住院血液样本）进行了进一步创新。拟议的研究合并了多个研究领域，并允许一个创新的和彻底的表征影响和社会背景的现实世界的相互作用。这项调查的结果将告知一些干预方法，包括家庭治疗，基于EMA的连续干预和药理学方法。

DESCRIPTION (provided by applicant): One third to one half of psychiatrically hospitalized youth is readmitted, with highest readmission risk 15-30 days post discharge and more than 80% readmitted within three months. The proposed study involves in vivo characterization of naturalistic phenomena associated with suicide risk after discharge adolescents using ecological methods and devices that allow acoustic capture of an individual's social environment and self-reports of experienced affect. We propose that social context and experienced affect are reciprocally reinforcing and that a reactive style involving close coupling of stressful social context (isolation, conflictual or high affect interactions) with affect reactivity (rapidly changig, intense affect, with slow return to baseline) increases risk for suicidal thoughts and behaviors. We also examine childhood maltreatment and epigenetic markers as predictors of post-discharge reactivity. Two hundred youth hospitalized for suicidal thoughts and behaviors will be followed prospectively using ecological methods and devices for three weeks following psychiatric discharge; suicidal thoughts and behaviors will be reassessed at 6 months. The present study further innovates through the incorporation of affect reactivity biomarkers (in-hospital blood samples for assessment of DNA/DNAm/expression). The proposed study merges multiple fields of study and permits an innovative and thorough characterization of the real-world interplay of affect and social context. Results of this investigation will inform a number of intervention approaches including family therapy, EMA-based adjunctive intervention, and pharmacological approaches.