Multimodal Assessment of Social Disconnection as a Proximal Risk for Suicide Ideation in Late Life

摘要/项目摘要 在全球和美国，老年人的自杀死亡率最高。研究表明 社会分离和人际负性生活事件（NLEs）与自杀有显著相关 构思，尝试和晚年死亡，但很少有研究探讨了关系的调节剂 社会脱节与晚年自杀之间的联系，或者认为社会脱节是 人际NLE和自杀结果之间的关系，尽管有令人信服的证据这样做。在 此外，现有的研究大多是横截面的，很少深入了解自杀风险如何在 小时、天、周和月。本提案的总体目标是利用 行为和社会机制的多模式评估，以提高我们识别特定 社会脱节与晚年自杀意念相关的预测因子。我们将研究一个关键的社会- 认知脆弱性，拒绝敏感性（RS），有助于社会脱节和 晚年自杀意念RS是主观感知、焦虑期待和强烈渴望的倾向。 对社会排斥的反应，并反映了社会过程的研究领域标准（RDoC）：归属和 附件.使用密集的纵向设计，包括三个21天EMA突破和后续 在为期一年的访谈中，我们还将研究社会脱节作为关系的中介 人际NLE和自杀意念之间的关系。与会者将包括一名 250名年龄在60岁及以上的男性和女性的诊断多样化样本，他们报告了自杀意念的增加。 基线的多模式评估将包括访谈、自我报告、基于实验室的社会排斥 范例，和21天的随机和基于事件的生态瞬时评估（EMA）协议。关注- up访谈将每3个月进行一次，为期1年，以全面评估罕见的、低基础率的人际关系 NLE（例如，死亡、疾病、关系丧失），并在6个月时重复21天EMA方案 和12个月。该项目有三个具体目标：1）研究社会中的人内变异性 断开连接作为晚年自杀意念瞬间增加的近端预测因子; 2）研究 RS作为社会分离和自杀之间关系的静态和时变调节剂 3）探讨社会分离对老年人思维能力的中介作用。 人际NLE和自杀意念在晚年的几小时，几天，几周和几个月的过程中。 研究结果将有助于制定基于证据的个性化治疗建议， 社会分离，社会排斥，人际NLE和晚年自杀意念的维度。

Abstract/Project Summary Globally and in the United States, older adults exhibit the highest rates of suicide deaths. Research has shown that social disconnection and interpersonal negative life events (NLEs) are both significantly linked with suicide ideation, attempts, and deaths in late life, yet few studies have examined moderators of the relationship between social disconnection and suicide in late life or considered social disconnection as a mediator of the relationship between interpersonal NLEs and suicide outcomes, despite compelling evidence to do so. In addition, existing studies are mostly cross-sectional and provide little insight into how suicide risk unfolds over hours, days, weeks, and months in older adults. The overarching goal of this proposal is to leverage a multimodal assessment of behavioral and social mechanisms to improve our ability to identify specific predictors relating social disconnection to suicidal ideation in late life. We will examine how a crucial social- cognitive vulnerability, rejection sensitivity (RS), contributes to the link between social disconnection and suicidal ideation in late life. RS is the predisposition to subjectively perceive, anxiously expect, and intensely react to social rejection, and reflects the Research Domain Criteria (RDoC) of Social Processes: Affiliation and Attachment. Using an intensive longitudinal design, including three 21-day EMA bursts and follow-back interviews over a 1-year period, we will also examine social disconnection as a mediator of the relationship between interpersonal NLEs and suicidal ideation over different timescales. Participants will include a diagnostically diverse sample of 250 men and women ages 60 and older who report elevated suicidal ideation. Multimodal assessments at baseline will include interviews, self-reports, a laboratory-based social rejection paradigm, and a 21-day random and event-based ecological momentary assessment (EMA) protocol. Follow- up interviews will be conducted every 3 months for 1-year to fully assess rare, low base rate interpersonal NLEs (e.g., deaths illnesses, loss of relationships), and the 21-day EMA protocol will be repeated at 6-months and 12-months. The proposed project has three specific aims: 1) to examine within-person variability in social disconnection as a proximal predictor of momentary increases in suicidal ideation in late life; 2) to investigate RS as a static and time-varying moderator of the relationship between social disconnection and suicidal ideation in late life; and 3) to examine the mediating effect of social disconnection on the relationship between interpersonal NLEs and suicidal ideation in late life over the course of hours, days, weeks, and months. Results will aid in the development of evidence-based personalized treatment recommendations targeting key dimensions of social disconnection, social exclusion, interpersonal NLEs, and suicidal ideation in late life.