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

抽象/项目总结

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.