Life Stressors, Impulsivity, and Adolescent Suicidal Behavior

简介(申请人提供)：自杀是青少年的第三大死因。尽管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较小。临床疗效的这些适度增长在一定程度上反映了这样一个事实， 虽然我们知道自杀行为的许多风险因素，但我们对它们如何增加风险知之甚少。事实上，自伤行为(即自杀未遂和非自杀性自伤[NSSI])的历史一直被发现是未来自杀未遂的最强预测因素。然而，关于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。尽管生活应激源和冲动与自杀行为的关系已经被广泛研究，并在自杀行为的几个理论模型中占有重要地位，但还没有研究表明它们如何相互关联来预测未来的自杀行为。这款新的Investigator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的这些风险因素的不同研究路线的发现，在当前知识中存在差距。具体地说，它将考察生活应激源、冲动性的不同神经认知/神经行为维度(包括两个RDoC结构，“奖励评估”和“反应选择、抑制或抑制”)和与损失相关的经历，与RDoC的损失结构相一致，可以解释过去的自杀企图如何增加未来复发的风险，这是一项多值纵向研究，样本为150名青少年住院患者。14-16岁的青少年将在精神科住院时以及出院后3个月、6个月、12个月和18个月完成最先进的生活压力访谈和对冲动的多方法和多维度评估。中心假设是，有自杀未遂历史的青少年将(A)经历更大的依赖应激源(即那些受自己行为影响的人)，以及(B)这种依赖应激源的比率增加，进而增加他们未来自杀未遂的风险。我们还假设，行为冲动同样会通过产生更大的依赖应激源来预测未来的自杀企图。我们还将研究NSSI是否预测依赖应激源，而依赖应激源又预测未来的自杀企图。这项研究的发现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表明不同的临床方法的前景(例如，在依赖压力源的情况下进行行为矫正，以及在独立压力源的情况下进行应对技能)。这个

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