Risk and resilience to late-life suicidal ideation and behavior after spousal bereavement: Targeting social connectedness to strengthen circadian rhythmicity

丧偶后晚年自杀意念和行为的风险和复原力：以社会联系为目标，加强昼夜节律

• 批准号: 10722523
• 负责人: Sarah T Stahl
• 金额: $ 78.66万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10722523
• 关键词: Acute; Adult; Age; Behavior; Behavioral; Behavioral Mechanisms; Bereavement; Biological; Cessation of life; Circadian Rhythms; Clinical; Clinical assessments; Data; Dimensions; Disease remission; Distress; Elderly; Enrollment; Event; Feeling; Feeling suicidal; Hour; Individual; Intervention; Investigation; Investigational Therapies; Life; Life Style; Loneliness; Measures; Mediator; Mental Depression; Methods; Natural experiment; Participant; Pathway interactions; Pattern; Periodicity; Persons; Phase; Recording of previous events; Research; Rest; Risk; Risk Factors; Self Care; Sleep; Social Change; Socialization; Spouses; Statistical Models; Suicide; Suicide attempt; Testing; Time; Widow; Widowhood; Withdrawal; acceptability and feasibility; actigraphy; aged; biobehavior; circadian; depressive symptoms; design; digital health; experience; geriatric depression; high dimensionality; human old age (65+); ideation; improved; individual variation; longitudinal design; mortality; person centered; prospective; reducing suicide; resilience; sex; sleep onset; sleep pattern; social; social integration; social stressor; suicidal; suicidal behavior; suicidal morbidity; suicidal risk; therapy development

PROJECT SUMMARY / ABSTRACT Our past research has demonstrated that feelings of social disconnectedness and conflictual relationships are factors that often undermine deterrents to suicide. Experiencing the death of a spouse or life partner is a profoundly distressing event that may cause abrupt changes in one’s daily routine, including decreased self- care and withdrawal from social activities. While most individuals adapt over time, a substantial number of older bereaved spouses (20-35%) experience depression, loneliness, suicidal thoughts, and early mortality, including death by suicide. Thus, late-life spousal bereavement provides a “natural experiment” in which to study the impact of a well-defined and common social stressor on suicide risk in late life. The objective of this R01 application is to examine the risk for and resilience to late-life suicide during the early spousal bereavement period by investigating the extent to which (1) social connectedness influences suicide risk and (2) whether circadian rhythm instability (inconsistent patterns of sleep, activity, meals, and socialization) helps explain this association. We will enroll 169 spousally-bereaved adults aged 65 years or older, who currently have at least subthreshold symptoms of depression or have a history of depression and/or suicide attempt. We will include participants early after spousal death: during the first six months post loss. All participants will complete repeated assessments over 12 months of multiple dimensions of social connectedness, clinical assessments (depression and suicide ideation), and objective assessments of circadian rhythmicity (actigraphy-derived 24-hour patterns of rest/activity, sleep onset and timing, and circadian phase advances or delays). Thus, we will be able to investigate whether circadian rhythmicity and delayed sleep onset and timing will be associated with higher suicide risk. Participants will also complete a behavioral probe, designed to promote self-care behaviors in older bereaved spouses (called “WELL” or Widowed Elders’ Lifestyle After Loss), a digital health intervention. WELL targets the timing and regularity of social activities, sleep, and meals to determine whether modifying social connectedness reduces suicide risk and whether circadian rhythm stability explains part of this association. Preliminary data indicate that WELL increases both (a) stability of circadian rhythms (i.e., regular sleep, activity, meals, and socialization) and (b) social connectedness. We will take full advantage of our longitudinal design and repeated assessments by using high-dimensional statistical models to examine how longitudinal change in multiple dimensions of social connectedness relates to change in circadian rhythm stability as a possible biobehavioral mechanism, and whether it directly and/or indirectly effects suicide risk in late-life. The proposed research aligns with RFA MH-22-135 by identifying (1) “mechanisms by which social disconnection confers risk for, and social integration protects against suicidal thoughts and behaviors in late life;” and (2) ”biological and behavioral mechanisms that can be targets within an experimental therapeutic approach of intervention development.”

项目总结/摘要 我们过去的研究表明，社会脱节和冲突关系的感觉， 这些因素往往会削弱自杀的威慑力。经历配偶或生活伴侣的死亡是一种 严重的痛苦事件，可能会导致一个人的日常生活发生突然变化，包括自我意识下降， 照顾和退出社会活动。虽然大多数人会随着时间的推移而适应，但也有相当多的人 失去亲人的老年配偶（20-35%）经历抑郁、孤独、自杀念头和过早死亡， 包括自杀因此，晚年配偶丧亲提供了一个“自然实验”， 研究一个明确定义的和常见的社会压力对晚年自杀风险的影响。的目的 R 01应用程序是检查在早期配偶期间晚年自杀的风险和弹性 通过调查（1）社会联系对自杀风险的影响程度， (2)昼夜节律不稳定（睡眠、活动、饮食和社交模式不一致）是否有助于 解释一下这种关联。我们将招募169名年龄在65岁或以上的丧偶成年人，他们目前 至少有抑郁症的阈下症状或有抑郁症和/或自杀企图史。我们 将包括配偶死亡后早期的参与者：在失去配偶后的前六个月内。所有参与者将 在12个月内完成对社会联系多个维度的重复评估，临床 评估（抑郁和自杀意念），以及昼夜节律的客观评估 （活动记录仪衍生的24小时休息/活动模式、睡眠开始和时间以及昼夜节律相位提前，或 延迟）。因此，我们将能够研究昼夜节律和延迟的睡眠开始和时间是否 会有更高的自杀风险参与者还将完成一项行为探测， 促进老年丧亲配偶的自我照顾行为（称为“WELL”或丧偶老人的生活方式后， 损失），数字健康干预。WELL针对社交活动、睡眠和用餐的时间和规律性 以确定改变社会联系是否会降低自杀风险， 稳定性解释了这种关联的一部分。初步数据表明，WELL增加了（a） 昼夜节律（即，有规律的睡眠、活动、饮食和社会化）和（B）社会联系。我们将 充分利用我们的纵向设计和重复评估，使用高维统计 研究社会联系多个维度的纵向变化与变化之间关系的模型 在昼夜节律稳定性作为一种可能的生物行为机制，以及是否直接和/或间接 影响晚年的自杀风险。拟议的研究通过确定（1）与RFA MH-22-135保持一致 “社会脱节带来自杀风险和社会融合防止自杀的机制 晚年的思想和行为;“和（2）”生物和行为机制，可以成为目标， 一种实验性的干预治疗方法。”