A fine-grained EEG/ERP examination of reward processing in suicide attempters

项目摘要 自杀是19至34岁人群的第二大死因和第三大死因 美国的年龄在35岁到54岁之间。尽管1999至2014年间自杀率上升了24%，但 菲尔德预测自杀死亡风险的能力在过去50年里没有提高，这表明 需要研究来确定新的、具体的风险机制。鉴于最近的证据表明， 自杀未遂(SA)是比之前认为的更高的晚期自杀风险因素，这是一个关键 重点应放在增加SA风险的因素上。尽管SA以跨诊断方式发生(即跨 广泛的诊断以及在没有可诊断的疾病的情况下)，迄今为止的大多数研究都 采取了一种特定于障碍的方法来理解SAS。此外，尽管有证据表明奖励存在异常 在自杀未遂者身上发挥作用，人们对奖赏处理的哪些具体组成部分知之甚少 在有SA病史的人中受损最严重，特别是(即预期快感、消耗性快感、 奖励学习)。此外，尽管有证据表明，一些人口统计和其他变量 与SA的存在和特征不同地联系在一起，这些变量对 自杀未遂者的奖励过程仍不清楚。为了解决先前研究的局限性， 拟议的研究将提供一项细粒度的奖赏加工的跨诊断调查 没有跨多个分析单元的SA病史(例如，脑电/事件相关电位， 行为、自我报告)。具体目标1是采用细粒度的多单元分析方法来检查 有SA病史个体的预期性和完成性奖赏加工和奖赏学习， 与那些没有这样的历史的人相比。具体目标2是确定奖励加工的专一性 个人的SA病史与他们现在或过去的精神病理学史的损害。最后，一个 探索性目标是检验性、性取向、种族/民族和SA的潜在调节作用 特征(即单次尝试与多次尝试、致命性和最后一次尝试的近期)。拟议中的项目 直接涉及2016年NIMH战略计划中概述的四个战略目标中的第一个--“定义 复杂行为的机制。拟议的项目还有可能提供有价值的 符合NIMH第四个战略目标--“努力预防和治疗”的信息。的确， 确定自杀未遂者的特定奖赏系统中断可能会提供重要信息 需要改进对这一特定、极高风险人群的干预或预防工作。

Project Summary Suicide is the second leading cause of death for 19- to 34-year-olds and the third leading cause of death for 35- to 54-year olds in the United States. Despite a 24% increase in suicide rates between 1999 and 2014, the field’s ability to predict risk for death by suicide has not improved in the past 50 years, indicating an urgent need for studies to identify novel, specific mechanisms of risk. Given recent evidence that a history of prior suicide attempt (SA) is an even greater risk factor for later completed suicide than previously thought, a key focus should be on factors that increase risk for SA. Although SAs occur transdiagnostically (i.e. across a broad range of diagnoses as well as in the absence of a diagnosable disorder), most research to date has taken a disorder-specific approach to understanding SAs. Further, despite evidence for abnormalities in reward functioning in suicide attempters, little is known about which specific components of reward processing may be most impaired in those with a history of SA, specifically (i.e. anticipatory pleasure, consummatory pleasure, reward learning). In addition, although there is evidence that a number of demographic and other variables are differentially linked with the presence and characteristics of SAs, the potential impact of these variables on reward processing in suicide attempters remains unclear. To address the limitations of prior research, the proposed study will provide a fine-grained transdiagnostic investigation of reward processing in those with and without a history of SA across multiple units of analysis (e.g., electroencephalography/event-related potentials, behavior, self-report). Specific Aim 1 is to take a fine-grained multiple-units-of-analysis approach to examine anticipatory and consummatory reward processing and reward learning in individuals with a history of SA, compared to those without such history. Specific Aim 2 is to determine the specificity of reward-processing impairments to individuals’ history of SA versus their current or past histories of psychopathology. Finally, an exploratory aim is to examine the potential moderating roles of sex, sexual orientation, race/ethnicity, and SA characteristics (i.e., single vs. multiple attempt, lethality, and recency of last attempt). The proposed project directly addresses the first of the four Strategic Objectives outlined in the NIMH Strategic Plan 2016 - “Define the mechanisms of complex behaviors.” The proposed project also has the potential to provide valuable information that is in line with the fourth NIMH Strategic Objective – “Strive for prevention and cures.” Indeed, identification of specific reward system disruptions in suicide attempters might provide important information needed to improve intervention or prevention efforts with this specific, extremely high-risk population.