Toward Optimizing Behavioral Markers of Suicide Risk

尽管正在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的自杀风险。 自杀意念和相关因素（例如，意图、计划、获得手段）来确定风险水平。依赖 自我报告是有问题的，因为许多患者不愿意或不能报告的想法和意图， 1除了这些局限性，自我报告措施对有意识思想的强调， 情绪几乎没有培养对无意识认知过程的洞察力，这些认知过程被理论化为 这些与自杀有关的认知过程，或习惯性的思维方式， 自杀，被认为是出现在个人变得痛苦，但在其他时间可能是休眠。这 “自杀认知反应”的概念与临床医生和患者的观察一致， 在临床访谈中，个体的自杀想法和意图可能不存在，但随后会迅速重新出现 在危难的时候。虽然自杀认知反应被认为是一个关键的潜在因素， 自杀风险的机制，它几乎没有得到实证评估，因为没有任何 建立程序来引出和评估它。引出和评估自杀认知反应的能力可以 在临床上非常有用。如果临床医生能够评估自杀想法和意图的可能性， 在不久的将来，他们将能够更准确地确定病人的自杀风险。我们 已经开发并初步测试了一种程序，使用自杀特异性 情绪诱导和计算机化的反应时间任务（即，死亡/自杀内隐关联测试，4和 自杀Stroop 5）隐含地测量认知过程（即，将自我与死亡联系起来， 对自杀相关线索的关注），并预测了高风险平民的自杀企图， 退伍军人。4，6，7这些任务作为自杀风险的行为标记。尽管前景看好，但任务仍然是 不太准确。这可能是由于与自杀相关的认知过程在一些参与者中不活跃 在评估的时候。为了优化任务和测试的关键理论预测，困扰 激活自杀想法，拟议的研究将检查死亡/自杀暗示的分数， 在参与者中诱导焦虑情绪之前和之后的关联测试和自杀Stroop任务， 让他们看一段关于自杀的电影片段这项研究将比较两组 退伍军人：（1）患有或曾经患有情绪焦虑和/或创伤相关疾病的“自杀组”， 在过去一年内曾企图自杀;及（2）“无自杀组别”， 情绪焦虑和/或创伤相关障碍，但从未认真考虑过自杀。如果 自杀行为的认知理论2，3是正确的，自杀组将显示出显着更大的增加， 自杀相关认知过程中情绪诱导后比任何一种表现出的增加都少 自杀小组。六个月后，参与者将完成面试，以确定他们是否尝试过 自第一次评估会议以来，自杀。如果利用我们的自杀特定情绪诱导确实优化了 这些任务的准确性，从最初的评估会议后情绪诱导分数应该预测 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 (e.g.,心理健康诊断、患者预测、自杀意念的严重程度）。客观评估的能力 潜在的过程，潜在的自杀风险和退伍军人的韧性可能会显着有助于 退伍军人健康管理局努力防止自杀。此外，拟议研究的结果，测试a 该领域最著名的自杀行为模型之一的关键组成部分，将为未来的研究提供信息。 研究什么时候，为什么，以及如何退伍军人有自杀的风险。

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.