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， 社交脱节和人际负性生活事件都与自杀有显著联系 晚年的思维、尝试和死亡，但很少有研究考察这种关系的调节因素 在晚年的社会脱节和自杀之间，或者被认为是社会脱节的中介 人际关系不良与自杀结局之间的关系，尽管有令人信服的证据表明这一点。在……里面 此外，现有的研究大多是横断面的，对自杀风险是如何展开的几乎没有提供深入的见解。 在老年人中，几小时、几天、几周、几个月。这项提案的首要目标是利用 对行为和社会机制的多模式评估，以提高我们识别具体问题的能力 将社会脱节与晚年自杀意念联系起来的预测者。我们将研究一个关键的社会- 认知脆弱性，拒绝敏感度(RS)，有助于社会疏离和拒绝之间的联系 晚年的自杀念头。RS指的是主观地感知、焦虑地期望和强烈地 对社会拒绝的反应，并反映了社会过程的研究领域标准(RDoC)：从属关系和 依恋。使用密集的纵向设计，包括三个21天的均线突发和后续 在为期一年的采访中，我们还将考察社会脱节作为关系的调停者 在不同的时间尺度上，人际关系不良生活事件与自杀意念之间的关系。参与者将包括一名 250名60岁及以上的男性和女性的诊断样本多样化，他们报告有更高的自杀意念。 基线的多模式评估将包括面谈、自我报告、基于实验室的社会拒绝 范例，以及为期21天的随机和基于事件的生态瞬时评估(EMA)协议。以下为- UP面谈将每3个月进行一次，为期一年，以全面评估罕见的、低基本率的人际关系 NLEs(如死亡、疾病、失去关系)和为期21天的EMA方案将在6个月内重复 还有12个月。拟议的项目有三个具体目标：1)检查社会中的人内可变性 断线是晚年自杀意念短暂增加的近端预测因子；2)调查 社会疏离与自杀之间关系的静态和时变调节变量 以及3)考察社会脱节对人与人之间关系的中介作用 在几个小时、几天、几周和几个月的过程中，人际关系不良和晚年的自杀意念。 结果将有助于制定针对关键疾病的循证个性化治疗建议 社会疏离、社会排斥、人际关系不良生活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.