The Developmental Psychopathology of Suicidal Ideations and Cognitions in Childhood

摘要：青春期前儿童的自杀想法和行为(STB)显著增加。 美国疾病控制与预防中心报告了过去十年的情况。10-14岁儿童自杀死亡人数增加一倍以上 2007年至2014年，非致命性自我伤害的比率在同一时期翻了一番。尽管 STB发病率的戏剧性上升，几乎没有关于患病率、发病时间或 青春期前儿童STB或非自杀性自残(NSSI)的相关因素和原因。在纵向研究中 在学龄前抑郁方面，我们报告了学龄前起病的STB在整个童年时期表现出稳定性。在外部 病例报告中，没有关于儿童早期STB或NSSI的其他已发表的数据。我们的发现，采取 与疾控中心的数据一起，支持从儿童早期开始研究STB和NSSI的迫切需要 确定儿童中期和青春期STB和NSSI的预测因子。在3-7岁儿童的样本中 在对抑郁症的治疗研究进行筛查时，我们再次发现NSSI(21.3%)和STB的比率高得惊人 (19.4%)。NIMH的补充资金被授予研究特征和神经 以及抑郁样本中STB和NSSI的行为相关性，并添加年龄匹配的健康人群 控制。我们在幼儿中发现了STB和NSSI的共同和独特的危险因素，这与 现存的青春期文学。在这些发现的基础上，我们建议遵循这个具有良好特征的样本 进入学龄期和青春期早期来测试这些现象的发展模型。我们会调查的 早发性STB和NSSI的纵向病程、中介和调节因子以及神经相关性。我们会 在N=314个人的样本中，在相隔18个月的两个时间点进行行为和事件相关电位评估 有学龄前儿童时期的数据。我们还将采样频率、强度和近端沉淀物 STB/NSSI使用每周小型评估(WMA)。在初步调查结果的基础上，我们将使用ERPS进行测试 关于RDoC结构的假设映射到可能导致STB和NSSI的风险因素，包括 对奖励、错误和同伴拒绝的积极和消极反馈的反应。我们将测试特定的 关于NSSI和STB的共同风险因素(更严重的抑郁、同伴拒绝、不良生活)的假设 事件，严厉的育儿，以及更强大的ERP对损失和同伴拒绝的反应，以及迟钝的ERP 对胜利和社会接受的反应)以及可能对NSSI更具选择性的风险因素(更大 羞耻、易怒、自我批评和更高的疼痛耐受性)与STB(归属感减少，更大 绝望和自杀家族史)。鉴于已确定样本的基线年龄较小，我们 也有机会调查不同发育阶段的风险差异。建议数 这项研究提供了一个前所未有的机会来跟踪有史以来最大的STB和STB儿童样本 NSSI将调查学龄期和青春期早期的发展轨迹，潜在地确定 早期干预的早期发育目标。

Abstract: A marked increase in suicidal thoughts and behaviors (STB) among pre-pubertal children over the last decade has been reported by the CDC. Death by suicide in children ages 10-14 more than doubled between 2007 and 2014 with rates of non-lethal self-inflicted injuries doubling during the same period. Despite these dramatic rises in STB rates, there has been little investigation of the prevalence, timing of onset, or correlates and causes of STB or non-suicidal self-injury (NSSI) in pre-pubertal children. In a longitudinal study of preschool depression, we reported that preschool-onset STB shows stability across childhood. Outside of case reports, there are no other published data on STB or NSSI in early childhood. Our findings, taken together with the CDC data, support the critical need for studies of STB and NSSI that start in early childhood to identify the predictors of STB and NSSI in middle childhood and adolescence. In a sample of 3-7 year olds screened for a treatment study of depression we again found alarmingly high rates of NSSI (21.3%) and STB (19.4%) at baseline. Supplemental NIMH funding was awarded to investigate the characteristics and neural and behavioral correlates of STB and NSSI in this depressed sample, and to add age matched healthy controls. We found both common and unique risk factors for STB and NSSI in young children, consistent with the extant adolescent literature. Building on these findings, we propose to follow this well characterized sample into school age and early adolescence to test developmental models of these phenomena. We will investigate the longitudinal course, mediators and moderators, and neural correlates of early onset STB and NSSI. We will conduct behavioral and ERP assessments at two time points, 18-months apart in our sample of N=314 who have data from the preschool period. We will also sample the frequency, intensity, and proximal precipitants of STB/NSSI using weekly mini-assessments (WMA). Building on preliminary findings, we will use ERPs to test hypotheses about RDoC constructs that map to the risk factors that may contribute to STB and NSSI, including responses to negative and positive feedback to reward, errors, and peer rejection. We will test specific hypotheses about both shared risk factors for NSSI and STB (greater depression, peer rejection, adverse life events, and harsh parenting, as well as stronger ERP responses to loss and peer rejection, and blunted ERP responses to wins and social acceptance) as well as risk factors that may be more selective for NSSI (greater shame, irritability, self-criticism and higher pain tolerance) versus STB (reduced belongingness, greater hopelessness and a family history of suicide). Given the young age of the ascertained sample at baseline, we also have the opportunity to investigate differences in risk as a function of developmental stage. The proposed study provides an unprecedented opportunity to follow the largest ever sample of young children with STB and NSSI to investigate developmental trajectories into school age and early adolescence, potentially identifying early developmental targets for earlier intervention.