Life Stressors, Impulsivity, and Adolescent Suicidal Behavior

生活压力、冲动和青少年自杀行为

• 批准号: 9197343
• 负责人: Richard T Liu
• 金额: $ 41.26万
• 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/9197343
• 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; Impulsive Behavior; Impulsivity; Individual; Inpatients; Intervention; Interview; Knowledge; Laboratories; Life; Life Stress; Link; Literature; Longitudinal Studies; Measures; Mediating; Mental Depression; Methodology; Methods; National Institute of Mental Health; Nature; Neurocognitive; Pain; Pain Threshold; Pathway interactions; Patient Self-Report; Prevention strategy; Process; Psychopathology; Public Health; Recording of previous events; Recurrence; Relative Risks; Research; Research Domain Criteria; 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; clinical application; clinically significant; comparative; design; experience; high risk; innovation; intervention effect; intervention program; neurobehavioral; non-suicidal self injury; peer; programs; prospective; public health relevance; reducing suicide; response; secondary analysis; stressor; suicidal; suicidal adolescent; suicidal behavior; suicidal risk; suicide model; theories

DESCRIPTION (provided by applicant): 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 multivalve 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

描述（由申请人提供）：自杀是青年死亡的第三大原因。虽然近几十年来在确定自杀行为的危险因素方面取得了相当大的进展，但临床干预计划的改善相对温和。这些临床有效性的适度提高部分反映了这样一个事实， 虽然我们知道许多自杀行为的危险因素，但我们对它们如何增加风险知之甚少。事实上，自我伤害行为的历史（即，自杀企图和非自杀性自伤[NSSI]）一直被发现是未来自杀企图的最强预测因素。然而，对解释过去和未来自杀行为之间联系的途径和过程的研究一直缺乏。虽然生活压力和冲动性与自杀行为的关系已被广泛研究，并在自杀行为的几个理论模型中表现突出，但没有研究探讨它们如何相互关联以预测未来的自杀行为。新的研究者应用程序将解决这些关键问题 通过整合和扩展关于自杀行为风险因素的不同研究路线的发现，弥补当前知识的空白。具体来说，它将研究如何生活压力，不同的神经认知/神经行为维度的冲动（包括两个RDoC结构，“奖励评价”和“反应选择，抑制或抑制”），和损失相关的经验，与RDoC结构的损失，可以解释如何过去的自杀企图增加风险，未来复发的多阀纵向研究与150名青少年住院患者的样本。14-16岁的青少年将在住院精神病患者入院时以及出院后3个月、6个月、12个月和18个月时完成最先进的生活压力访谈和多方法、多维度的冲动性评估。中心假设是，有自杀企图史的青少年将（a）经历更大的依赖性压力源（即，那些受他们自己行为影响的人），和（B）这种依赖性压力源的增加率，反过来又增加了他们未来自杀企图的风险。我们还假设，行为冲动将同样预测未来的自杀企图产生更大的依赖性压力。我们还将研究NSSI是否预测依赖性压力源，这反过来又预测未来的自杀企图。这项研究的结果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说明了不同临床方法的前景（例如，依赖性压力源的行为矫正和独立压力源的应对技能）。的