Neurocognitive markers of short-term risk for suicidal behavior in high-risk Veterans

高危退伍军人自杀行为短期风险的神经认知标志物

• 批准号: 10402840
• 负责人: CATHERINE E MYERS
• 金额: --
• 依托单位: VA NEW JERSEY HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-01-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10402840
• 关键词: Acute; Area; Behavior; Behavioral; Cessation of life; Chronic; Client; Clinical; Clinical assessments; Cognitive; Computer Models; Computers; Data; Death Rate; Development; Diffuse; Event; Feedback; Feeling hopeless; Health; Impulsivity; Individual; Interruption; Intervention; Learning; Measures; Mental Depression; Mental Health; Meta-Analysis; Methods; Neurocognitive; Opiate Addiction; Outcome Assessment; Patient Self-Report; Patients; Performance; Post-Traumatic Stress Disorders; Prevention approach; Process; Psychiatric therapeutic procedure; Punishment; Reporting; Research; Resources; Rewards; Risk; Risk Assessment; Risk Factors; Sampling; Semantics; Specificity; Suicide; Suicide attempt; Suicide prevention; Syndrome; Task Performances; Techniques; Testing; Therapeutic; Time; Treatment Effectiveness; Veterans; Work; attentional control; base; clinically relevant; cognitive process; cohort; computerized; computerized tools; evidence base; executive function; experience; high risk; improved; innovation; insight; instrument; medical specialties; military veteran; neurocognitive test; novel; novel strategies; predictive marker; predictive modeling; predictive tools; prospective; recruit; response; reward processing; screening; skills; substance use; suicidal; suicidal behavior; suicidal individual; suicidal morbidity; suicidal risk; telehealth; therapeutic target; trait

Project Summary/Abstract Given the high rates of Veteran suicide each year, suicide prevention has become a VHA strategic priority. While progress has been made in screening Veterans for suicide risk, high rates of false positives remain a challenge, potentially diverting clinical resources away from those Veterans who need them most. Innovative new approaches to assess suicide risk are needed, that accurately identify short-term (e.g. coming weeks) risk of suicidal behavior, and that are based on objective markers rather than relying primarily on self- report. Recent work has identified several cognitive domains, including impulse control and inhibition, increased distractibility, implicit semantic content, and processing of rewards/punishments, that may all be altered in suicidal individuals. The current project will use a battery of computer-based tests to assess these cognitive domains, followed by computational modeling to extract additional meta-variables representing latent cognitive processes, to prospectively predict short-term risk of suicidal behavior in high-risk Veterans. Veterans will be recruited from acute in-patient psychiatric units following a suicidal event, and tested at 3-month intervals for a year; we will also record suicidal behavior (SB), defined as an actual, interrupted, or aborted attempt or a behavior preparatory to suicide. In Aim 1, we will use neurocognitive task scores collected shortly before the SB, to determine which tasks (and therefore, alterations in which cognitive domains) can prospectively predict short-term risk of SB (within the next 3 months). In Aim 2, we will conduct computational modeling on the behavioral data, to extract additional meta-variables, describing latent cognitive processes such as response caution (impulsivity); subjective value of rewarding, punishing, and neutral feedback; perseveration; and tendency to explore new responses, to determine which of these meta-variables can prospectively predict SB. In Aim 3, we will combine these neurocognitive task scores and meta-variables, along with "standard" indicators of suicide risk such as demographic, self-report, and clinical assessment, in a statistical prediction model, to determine whether inclusion of these cognitive variables and meta-variables can significantly improve prediction of short-term risk for SB in this high-risk Veteran sample. The results of this study will provide much-needed information to improve identification of Veterans likely to make a suicide attempt in the upcoming weeks, so that clinical resources can be targeted to help them. The computer-based neurocognitive tests represent relatively objective behavioral markers that could be deployed fairly simply in a clinical setting or even via telehealth. Additionally, our focus on underlying cognitive processes, as modifiable factors, will improve the ability to optimize intervention by suggesting specific therapeutic approaches based on an individual Veteran's cognitive profile.

项目概要/摘要 鉴于每年退伍军人自杀率很高，预防自杀已成为 VHA 的一项战略 优先事项。虽然在筛查退伍军人自杀风险方面取得了进展，但误报率很高 仍然是一个挑战，可能会导致临床资源从最需要的退伍军人手中转移。 需要创新的新方法来评估自杀风险，准确识别短期（例如即将到来的）自杀风险。 周）自杀行为的风险，并且基于客观标记而不是主要依靠自我 报告。最近的工作已经确定了几个认知领域，包括冲动控制和抑制， 增加注意力分散、隐含的语义内容以及奖励/惩罚的处理，这些都可能是 自杀者的改变。 当前的项目将使用一系列基于计算机的测试来评估这些认知领域， 随后进行计算建模以提取代表潜在认知的额外元变量 过程，前瞻性预测高风险退伍军人自杀行为的短期风险。退伍军人 将从自杀事件后的急性住院精神科病房招募，并在 3 个月后进行测试 间隔一年；我们还将记录自杀行为（SB），定义为实际的、中断的或中止的 企图自杀或准备自杀的行为。在目标 1 中，我们将使用不久收集到的神经认知任务分数 在 SB 之前，确定哪些任务（以及因此哪些认知领域的改变）可以 前瞻性预测SB的短期风险（未来3个月内）。在目标 2 中，我们将进行计算 对行为数据进行建模，提取额外的元变量，描述潜在的认知过程 如反应谨慎（冲动）；奖励、惩罚和中立反馈的主观价值； 坚持不懈；以及探索新反应的倾向，以确定这些元变量中的哪些可以 前瞻性预测SB。在目标 3 中，我们将结合这些神经认知任务分数和元变量， 连同自杀风险的“标准”指标，例如人口统计、自我报告和临床评估， 统计预测模型，以确定包含这些认知变量和元变量是否可以 显着提高了对这个高风险退伍军人样本中 SB 短期风险的预测。 这项研究的结果将为改善退伍军人的识别提供急需的信息 可能在未来几周内尝试自杀，因此可以有针对性地提供临床资源来帮助 他们。基于计算机的神经认知测试代表了相对客观的行为标记，可以 在临床环境中甚至通过远程医疗部署相当简单。此外，我们关注潜在的认知 流程作为可修改的因素，将通过提出具体建议来提高优化干预的能力 基于个体退伍军人认知状况的治疗方法。