Toward Optimizing Behavioral Markers of Suicide Risk

尽管不断努力加强自杀风险评估，但目前的方法严重依赖于患者报告 自杀意念和相关因素(如意图、计划、获得手段)，以确定风险水平。依赖于 自我报告是有问题的，因为许多患者不愿意或无法报告其想法和意图 自杀1.除了这些限制外，自我报告措施的重点是有意识的想法和 情绪几乎没有培养出对大部分无意识认知过程的洞察，这些认知过程被理论上认为 2，3这些与自杀有关的认知过程，或促进自杀的习惯性思维方式 自杀被认为是当个体变得痛苦时出现的，但在其他时候可能处于休眠状态。这 自杀认知反应性的概念与临床医生和患者的观察一致，对某些人来说 个人的自杀想法和意图可能会在临床访谈中消失，但随后很快就会浮出水面 在危难的时刻。尽管自杀的认知反应据称是一种关键的潜在因素 关于自杀风险的作用机制，很少有实证评价，因为还没有任何 建立了引出和评估它的程序。诱发和评估自杀认知反应性的能力可能 在临床上非常有用。如果临床医生能够评估自杀念头和意图的可能性 在不久的将来出现，它们将能够更准确地确定患者的自杀风险。我们 已经开发并试点测试了一种程序来评估自杀认知反应，该程序使用特定于自杀的 情绪诱导和计算机化的反应时间任务(即死亡/自杀内隐联想测试，4和 隐含测量认知过程(即，自我与死亡的联系)的自杀性心理障碍，以及偏见 对自杀相关线索的关注)，并预测高危平民和 退伍军人。4、6、7这些任务是自杀风险的行为标志。尽管前景看好，但这些任务仍然 不是很准确。这可能是由于一些参与者与自杀相关的认知过程不活跃所致。 在评估时。为了优化任务并检验危难的关键理论预测 激活自杀想法，这项拟议的研究将检查死亡/自杀隐含的分数 被试焦虑情绪诱发前后的联想测验和自杀Stroop任务 让他们观看一部与自杀有关的电影中的一个简短场景。这项研究将比较两组 退伍军人：(1)有或曾经有情绪焦虑和/或创伤相关障碍和 在过去一年内曾试图自杀；及(2)“无自杀团体”，同样有或有/曾经有过自杀行为 情绪焦虑和/或创伤相关障碍，但从未认真考虑过试图自杀。如果 自杀行为认知理论2、3是正确的，自杀组将呈现明显较大幅度的增长 情绪诱导后与自杀相关的认知过程比NO表现的任何增加 自杀组织。六个月后，参与者将完成一次面试，以确定他们是否尝试过 从最初的评估会议开始自杀。如果利用我们特定于自杀的情绪感应确实优化了 这些任务的准确性，最初评估阶段的后情绪诱导分数应该可以预测 自杀企图超过情绪诱导前得分和其他自杀风险的常见指标 (例如，精神健康诊断、患者预测、自杀意念的严重程度)。客观评估的能力 退伍军人中潜在的自杀风险和复原力的潜在过程可能对 退伍军人健康管理局努力防止自杀。此外，拟议研究的结果是，测试 该领域最著名的自杀行为模式之一的关键组成部分，将为未来 关于退伍军人何时、为什么以及如何面临自杀风险的研究。

Despite ongoing efforts to enhance suicide risk assessment, current methods rely heavily on patient report of suicidal ideation and related factors (e.g., intent, plan, access to means) to determine level of risk. Reliance on self-report is problematic because many patients are unwilling or unable to report thoughts and intentions of suicide.1 In addition to these limitations, the emphasis of self-report measures on conscious thoughts and emotions has fostered little insight into the largely unconscious cognitive processes that are theorized to underlie suicidal crises.2,3 These suicide-related cognitive processes, or habitual ways of thinking that promote suicide, are believed to emerge when individuals become distressed, but at other times may be dormant. This notion of “suicidal cognitive reactivity” is consistent with clinicians’ and patients’ observations that for some individuals suicidal thoughts and intentions may be absent during a clinical interview, but then rapidly resurface in the presence of distress. Although suicidal cognitive reactivity is purported to be a critical underlying mechanism of suicide risk, it has received little empirical evaluation because there have not been any established procedures to elicit and assess it. The ability to elicit and assess suicidal cognitive reactivity could be extremely clinically useful. If clinicians could assess the likelihood of suicidal thoughts and intentions emerging in the near future, they would be better able to accurately determine patients’ risk of suicide. We have developed and pilot tested a procedure to evaluate suicidal cognitive reactivity using a suicide-specific mood induction and computerized reaction-time tasks (i.e., the Death/Suicide Implicit Association Test,4 and the Suicide Stroop5) that implicitly measure cognitive processes (i.e., association of self with death, and biased attention toward suicide-related cues) and have predicted suicide attempts among high-risk civilians and Veterans.4,6,7 These tasks serve as behavioral markers of suicide risk. Although promising, the tasks are still not very accurate. This may be due to suicide-related cognitive processes not being active in some participants at the time of assessment. In order to optimize the tasks and test the critical theoretical prediction that distress activates suicidal thinking, the proposed research will examine scores on the Death/Suicide Implicit Association Test and Suicide Stroop task both before and after inducing a dysphoric mood in participants by having them watch a brief scene from a movie having to do with suicide. The study will compare two groups of Veterans: (1) a “Suicide Group” who have or have had a mood anxiety and/or trauma related disorder and have attempted suicide within the past year, and (2) a “No Suicide Group” who similarly have or have/had a mood anxiety and/or trauma related disorder, but have never seriously considered attempting suicide. If the cognitive theory of suicidal behavior2,3 is correct, the Suicide Group will display a significantly larger increase in suicide-related cognitive processes following the mood induction than any increase displayed by the No Suicide Group. Six-months later, participants will complete an interview to determine if they have attempted suicide since the initial assessment session. If utilizing our suicide-specific mood induction does optimize the accuracy of these tasks, the post-mood induction scores from the initial assessment session should predict suicide attempts over and above the pre-mood induction scores and other common indicators of suicide risk (e.g., mental health diagnosis, patient prediction, severity of suicidal ideation). The ability to objectively assess latent processes underlying both suicide risk and resilience among Veterans could significantly contribute to Veterans Health Administration efforts to prevent suicide. Furthermore, results of the proposed study, testing a critical component of one of the field’s most prominent models of suicidal behavior, would inform future research on when, why, and how Veterans are at risk for suicide.