Non-Suicidal Self-Injury in Children: Brain/behavior Alterations and Risk for Suicidal Behavior

项目摘要/摘要： 背景：非自杀性自我伤害(NSSI)--定义为故意破坏一个人的身体 缺乏死亡意图(最常见的是自残)--在7-24岁的紧急情况下占25% 每年都有部门进行自我伤害，并将自杀未遂(SA)的风险增加多达7倍。 此外，自杀是美国10-24岁青少年死亡的第二大原因。因此，有一个关键 需要确定NSSI本身的大脑/行为机制以及电路/行为/症状 预测哪些年轻人只参与NSSI会导致首发SA(哪些不会)。这个 主要目标是(1)确定功能磁共振成像(FMRI)在以下方面的差异 参与NSSI的年轻人与没有精神病理的对照组，(2)确定电路，行为，和 与首发SA相关的症状因素，以及(3)测试这种关系的调节因素，包括 易怒、社会功能和冲动攻击性。我们的中心假设，基于初步的 来自我们的美国预防自杀基金会对参与NSSI的青少年的研究数据-仅是(A) 参与NSSI的年轻人-只有在没有事先SA的情况下才会在前额叶皮质(PFC)发生行为/回路改变- 在任务中杏仁核回路挖掘与自杀和对同伴接纳的反应与。 拒绝，以及(B)这些回路改变，由易怒、冲动攻击性和社会性缓和 功能障碍，使年轻人面临更大的未来自杀行为的风险。研究方法：我们将对此进行检验 通过比较150名仅参加NSSI(没有先前的SA)的年轻人和50名典型发育的年轻人的假设 控制(TDC)青少年的电路、行为和症状测量，然后跟踪样本18 几个月的时间来描述那些进展到自杀行为的人的区别。这样做的理由是 建议是更多地了解NSSI背后的大脑/行为机制及其关系 到随后的首发SA最终将导致更基于大脑的分类和治疗方法 对于NSSI和自杀，这反过来将降低自杀行为的风险，并加强对 儿童和青少年。创新：我们的研究是创新的，因为它将独特地协同电路和 基于可靠的初步数据和创新的生态瞬时评估的行为方法 NSSI/自杀和易怒，对社会功能的真实世界评估，纵向跟踪，和承诺 多学科团队。意义：我们的研究很有意义，因为它解决了知识的差距 关于NSSI和NIMH/National强调的首发SA的生物行为机制 预防自杀行动联盟的“优先预防自杀研究议程”和 2016年6月NIMH主办的关于“自杀风险机制”的会议--因为这些机制提供了 NSSI和自杀的基于生物学机制的分类和治疗基础。

PROJECT SUMMARY/ABSTRACT: BACKGROUND: Non-suicidal self-injury (NSSI)—defined as deliberate destruction of one's body in the absence of intent to die (most commonly self-cutting)—accounts for 25% of 7-24 year olds seen in emergency departments annually for self-harm and increases the risk for a suicide attempt (SA) by as much as 7-fold. Moreover, suicide is the second leading cause of death of 10-24 year olds in the U.S. Thus, there is a critical need to identify the brain/behavior mechanisms underlying NSSI itself and also the circuit/behavior/symptoms predictors of which youths engaged in NSSI-only will make a first-onset SA (and which will not). THE PRIMARY OBJECTIVES are (1) to identify functional magnetic resonance imaging (fMRI) differences between youths engaged in NSSI vs. controls without psychopathology, (2) to determine the circuit, behavior, and symptom factors associated with first-onset SA, and (3) to test moderators of this relationship including irritability, social function, and impulsive aggression. OUR CENTRAL HYPOTHESIS, based on preliminary data from our American Foundation for Suicide Prevention study of teens engaged in NSSI-only is that (a) youths engaged in NSSI-only without a prior SA have behavior/circuit alterations in a prefrontal cortex (PFC)- amygdala circuit during tasks tapping implicit associations with suicide and response to peer acceptance vs. rejection, and (b) these circuit alterations, moderated by irritability, impulsive aggression, and social dysfunction, put youths at greater risk for future suicidal behavior. RESEARCH METHOD: We will test this hypothesis by comparing 150 youths engaged in NSSI-only (without prior SA) vs. 50 typically-developing control (TDC) youths on circuit, behavior, and symptom measures, and then following the sample for 18 months to delineate what distinguishes those who progress to suicidal behavior. THE RATIONALE FOR THIS PROPOSAL is that greater knowledge of the brain/behavior mechanisms underlying NSSI and the relationship to subsequent first-onset SA will ultimately lead to a more brain-based classification and treatment approach for NSSI and suicide, which in turn would reduce risk, and enhance prevention for, suicidal behavior among children and adolescents. INNOVATION: Our study is innovative because it will uniquely synergize circuit and behavioral methods based on solid preliminary data with innovative ecological momentary assessments of NSSI/suicide and irritability, real-world assessment of social function, longitudinal follow up, and a committed multi-disciplinary team. SIGNIFICANCE: Our study is significant because it addresses gaps in knowledge about bio-behavioral mechanisms of both NSSI and also of a first-onset SA highlighted by the NIMH/National Action Alliance for Suicide Prevention's (NAASP) “Prioritized Research Agenda for Suicide Prevention” and the June 2016 NIMH-sponsored meeting on “Mechanisms of Suicide Risk”—as these mechanisms provide the foundation for biological mechanism-based classification and treatments for NSSI and suicide.