Moving beyond the Pain-Suicidality Link: An Investigation of Fluctuations in Social Threat and Neural Response to Social Threat in Momentary Pain and Proximal Risk for Suicidal Ideation in Adolescence

项目总结/摘要 自杀率是青少年死亡的第二大原因。自杀意念（SI）通常发生在 在青春期。SI的发生是一个发展的转折点， 持续和恶化的SI和其他自我伤害的想法和行为。SI也与 显著的医疗保健成本、发病率和死亡风险。青春期身体疼痛的发生率增加 自杀风险的发展性增加。身体疼痛的存在与2- 3-SI风险增加一倍，促使几个主要组织（例如，世界卫生组织，美国 精神病学协会和美国自杀预防基金会）强调身体疼痛 条件是成人和10岁及以上儿童自杀的严重危险因素。多起自杀式 一些理论认为，自杀的想法和行为源于逃避无法忍受的痛苦的愿望，包括 肉体上的痛苦然而，关于疼痛与自杀联系的研究在很大程度上依赖于横断面研究 专注于疼痛诊断（例如，慢性疼痛）作为单一风险因素。然而，大多数患有疼痛的人 诊断没有SI。有必要进行纵向研究，调查多种风险因素如何起作用 共同影响SI。还需要识别SI的近端风险（例如，在几个小时内）， 经常在短时间内快速波动。我们将超越疼痛与自杀之间的联系， 可能影响青少年身体疼痛和SI近端风险动态变化的因素。我们 将调查社会威胁的短期影响（对社会地位或关系的威胁） 以及个体对社会威胁的神经反应差异对身体疼痛的瞬间增加， SI的近端风险。我们关注社会威胁，因为这是一种特别突出的发展类型， 在青春期的威胁，并已被证明会影响疼痛。社会威胁和身体威胁一样， 与疼痛有关的大脑区域参与“神经警报系统”，以警告危险。社会威胁也是一种 青春期SI的强纵向预测因子。填补在社会发展作用方面的知识空白， 威胁的痛苦自杀联系，我们将测试一个总体模型的组成部分，假设暴露于 社会威胁预示着疼痛的短暂增加（特别是疼痛和不愉快）。痛苦反过来又是 SI的近端预测因子。疼痛相关脑区的神经激活增强，以应对社会威胁 当社会威胁发生时，会放大SI的痛苦和风险。我们将进行纵向调查 对200名14-17岁的年轻人进行的研究，他们患有四肢、背部或颈部的复发性肌肉骨骼疼痛， 与自杀风险有关。我们将招募一系列疼痛严重程度的年轻人，但将 对高水平疼痛进行过采样，以丰富SI的风险。在基线时，青少年将完成fMRI任务， 测量对社会威胁的神经反应青年还将参加生态瞬时评估 社会威胁、疼痛和SI在几个小时内的真实波动。

PROJECT SUMMARY/ABSTRACT Suicide rates are the second leading cause of death in adolescence. Suicidal ideation (SI) typically develops in adolescence. The onset of SI is a developmental inflection point associated with pathways toward persistent and worsening SI and other self-injurious thoughts and behaviors. SI is also associated with significant health care costs, morbidity, and risk for mortality. Rates of physical pain increase in adolescence alongside the developmental increase in suicide risk. The presence of physical pain is associated with a 2- to 3-fold increase in SI risk, prompting several major organizations (e.g., World Health Organization, American Psychiatric Association, and American Foundation for Suicide Prevention) to highlight physical pain conditions as a serious risk factor for suicide in adults and children ages 10 years and older. Multiple suicide theories posit that suicidal thoughts and behaviors arise from the desire to escape unbearable pain, including physical pain. However, research on the pain–suicidality link has heavily relied on cross-sectional studies focusing on pain diagnoses (e.g., chronic pain) as a single risk factor. Yet, most individuals with a pain diagnosis do not have SI. There is a need for longitudinal studies investigating how multiple risk factors work together to influence SI. There is also a need to identify proximal risk for SI (e.g., over hours) given that SI often fluctuates rapidly over short periods. We will move beyond the pain–suicidality link by investigating factors that may influence dynamic changes in physical pain and proximal risk for SI among adolescents. We will investigate the effects of short-term effect of social threat (threat to social status or relationships) and individual differences in neural response to social threat on momentary increases in physical pain and proximal risk for SI. We focus on social threat because this is an especially developmentally salient type of threat in adolescence and has been shown to influence pain. Social threat, like physical threat, also activates pain-related brain regions involved in a “neural alarm system” to warn against danger. Social threat is also a robust longitudinal predictor of SI in adolescence. To address major gaps in knowledge of the role of social threat in the pain–suicidality link, we will test components of an overarching model positing that exposure to social threat predicts momentary increases in pain (particularly pain unpleasantness). Pain in turn is a proximal predictor of SI. Heightened neural activation in pain-related brain regions to social threat amplifies pain and risk for SI in the moments when social threat occurs. We will conduct a longitudinal study of 200 youth ages 14–17 with recurrent musculoskeletal pain in limbs, back, or neck, which is common in adolescents and associated with suicide risk. We will recruit youth with a range of pain severity, but will oversample for high levels of pain to enrich for risk for SI. At baseline, youth will complete fMRI tasks to measure neural response to social threat. Youth will also participate in ecological momentary assessments of real-world fluctuations in social threat, pain, and SI over hours.