权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Reward Valuation and Suicidal Behavior in High-Risk Adolescents

高危青少年的奖励评估和自杀行为

基本信息

批准号：
10655103
负责人：
AUTUMN J KUJAWA
金额：
$ 77.74万
依托单位：
VANDERBILT UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-04-07 至 2028-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10655103
关键词：
17 year old Acute Address Admission activity Adolescent Age Behavior Behavioral Buffers Cause of Death Clinical assessments Communication Complex Data Development Diagnostic Disclosure Economic Burden Electroencephalography Emotional Exhibits Feeling suicidal Frequencies Future Goals Health Hospitals Hour Individual Differences Interruption Intervention Interview Link Literature Longevity Measures Mental Depression Methods Modeling National Institute of Mental Health Pain Participant Pathway interactions Patient Self-Report Patients Pattern Positive Valence Predictive Factor Predisposition Process Prospective Studies Psychiatric therapeutic procedure Psychological reinforcement Psychopathology Public Health Recording of previous events Research Research Domain Criteria Research Priority Rewards Risk Risk Behaviors Risk Factors Sampling Social Environment Social support Stress Suicide Suicide attempt Suicide prevention Surveys System Techniques Telephone Testing Thinking Time Youth adolescent suicide behavior measurement behavioral outcome biomarker identification brain based cost effective direct application discounting follow-up high risk high-risk adolescents innovation insight neural neural circuit neuroimaging novel pleasure precision medicine preference prospective prospective test psychiatric symptom recruit reinforcer response reward processing social stressor suicidal adolescent suicidal behavior suicidal morbidity suicidal risk suicide model theories

项目摘要

PROJECT SUMMARY Suicide is a leading cause of death for adolescents worldwide, and rates have increased over the past decade. Yet, we lack reliable predictors of suicidal behavior (SB) due in part to a need to consider a broader range of risk processes and methods of assessment. There is a particularly critical and urgent need for research on objective, prospective predictors of SB to identify youth at greatest risk and elucidate novel targets for intervention. The goal of this study is to characterize alterations in RDoC’s Positive Valence Systems, particularly neural processes involve in reward valuation, in a large, high-risk sample of adolescents in acute psychiatric treatment for self-injurious thoughts and behaviors (SITBs) who will be followed for 6 months following discharge—a period of high risk for SB. Our preliminary data and theories of SB highlight a key role of reward valuation in that SB partly reflects a choice between immediate relief from emotional pain rather than waiting for potential future rewards that come from continuing to live through difficult times. Consistent with this, rigorous cross-sectional research has linked SB to greater discounting of the value of delayed monetary rewards, and our preliminary data indicate enhanced neural responsiveness to immediate relative to delayed rewards in youth with recent SB. Importantly, preferences for immediate rather than delayed reinforcers are known to increase in times of high stress, and acute interpersonal stress is associated with elevated risk for SB in adolescents, while social support tends to be protective. This multi-method, prospective study will test an innovative conceptual model of SB by which youth with enhanced neural reactivity to immediate reinforcers and blunted reactivity to delayed rewards are more likely to engage in SB, particularly in times of acute interpersonal stress, and social support buffers effects of reward valuation on SB. We will recruit a transdiagnostic sample of adolescents (ages 13-17 years; N=300) in acute psychiatric treatment for SITBs. Participants will complete clinical assessments and behavioral and neural measures of reward valuation in the hospital to capture a high-risk state and minimize participant burden. Following discharge, participants will complete a brief daily survey of interpersonal stress, social support, and SITBs for 90 days. Finally, participants will complete follow-up interviews of SITBs 6 months after discharge to test prospective predictors of SB. This study will characterize patterns of reward valuation associated with SB histories in high-risk youth (Aim 1), examine neural measures of reward valuation as prospective predictors of SB following hospital discharge (Aim 2), and examine the interplay between neural reward valuation and interpersonal factors in the proximal prediction of SB (Aim 3). This study directly addresses NIMH priorities and will be the first to examine neural predictors of future SB in a large, high-risk sample of youth, extending RDoC-informed research on suicide risk to the Positive Valence Systems domain. This research will lead to the identification of objective predictors of SB risk and the development of more personalized, targeted interventions to prevent SB and suicide deaths.

项目概要自杀是全世界青少年死亡的主要原因，并且自杀率在过去十年中有所上升。然而，我们缺乏可靠的自杀行为（SB）预测因素，部分原因是需要考虑更广泛的自杀行为风险流程和评估方法。尤其迫切需要进行以下方面的研究：客观、前瞻性的 SB 预测因子，以识别风险最大的青少年并阐明新的目标干涉。本研究的目标是表征 RDoC 正价系统的变化，特别是在大量高风险青少年样本中，涉及奖励评估的神经过程针对自残想法和行为 (SITB) 的精神治疗，将进行 6 个月的随访出院后——SB 的高风险期。我们的 SB 初步数据和理论凸显了关键作用 SB 的奖励评估部分反映了是立即缓解情感痛苦还是等待继续度过困难时期所带来的潜在未来回报。符合严格的横断面研究将 SB 与延迟货币价值的更大贴现联系起来奖励，我们的初步数据表明，相对于延迟的神经反应，对即时的反应有所增强奖励在青年时期与最近的SB。重要的是，对立即强化而不是延迟强化的偏好是已知在高压力时期会增加，而急性人际压力与 SB 风险升高相关对于青少年来说，社会支持往往是保护性的。这项多方法、前瞻性研究将测试 SB 的创新概念模型，通过该模型，青少年对直接强化物的神经反应性增强对延迟奖励的反应迟钝更有可能陷入 SB，特别是在紧急情况下人际压力和社会支持缓冲了奖励评估对 SB 的影响。我们将招募一名接受 SITB 急性精神治疗的青少年（13-17 岁；N=300）的跨诊断样本。参与者将完成临床评估以及奖励评估的行为和神经测量医院捕捉高风险状态并最大限度地减少参与者的负担。出院后，参与者将完成为期 90 天的关于人际压力、社会支持和 SITB 的简短每日调查。最后，参与者将在出院后 6 个月完成 SITB 的后续访谈，以测试 SB 的前瞻性预测因素。这研究将描述与高风险青少年的 SB 历史相关的奖励评估模式（目标 1），检查奖励评估的神经测量作为出院后 SB 的前瞻性预测因素（目标 2），并检查神经奖励评估与近端人际关系因素之间的相互作用 SB 的预测（目标 3）。这项研究直接解决 NIMH 的优先事项，并将是第一个检查神经在大量高风险青少年样本中预测未来 SB，扩展基于 RDoC 的自杀风险研究到正价系统域。这项研究将确定客观预测因素 SB 风险以及制定更加个性化、有针对性的干预措施以预防 SB 和自杀死亡。