Temporal dynamics of stress, sleep, and arousal in short-term risk for adolescentsuicidal behavior

虽然其他主要死亡原因大幅下降，但青年自杀率却有所上升。是 这是青少年死亡的第二大原因， 在过去的十年里翻了一番。在50年的研究中，该领域几乎完全集中在长期- 自杀结局的长期风险，平均随访期为10年。事实上，只有一个 研究了成年人自杀行为的短期风险，而青少年没有自杀行为。这是值得注意的，因为长期以来- 长期风险因素往往是短期风险的不良预测因素。因此，目前的证据基础 医疗保健提供者在确定近端风险和相应的适当临床 反应相当有限。青少年自杀行为的低基础率对以下人群尤其具有挑战性： 研究这一结果的短期风险，这在很大程度上解释了缺乏这方面的研究。 区为了克服这一困难，需要从高危人群中抽取大量样本。在当前 我们有独特的优势来解决这个问题。也就是说，我们将利用来自 我们目前对青少年精神病住院患者自杀风险的一项研究， 收集了200名新患者的样本，最终样本为400人。此外，最近的发展， 评估技术为阐明近端自杀的时间动力学提供了新的机会， 风险，从而解决难以捉摸的问题，不仅是一个人是否有从事自杀的风险， 行为在不久的将来，但当他们可能是最危险的。当前应用程序将评估唤醒（在 压力和睡眠障碍的形式）与使用门诊 评估措施。具体而言，采用生态瞬时评估，一个移动的生物传感器， 腕动计，我们的目标是评估随时间变化的压力（在心理和生理水平）的相互关系 和睡眠不规律的时间动态的风险自杀意念和事件（自杀企图和 急性自杀倾向的重症临床护理）。考虑到大脑前额叶皮层 参与调节唤醒，我们还将评估执行功能是否在基线温和 随时间变化的压力和睡眠不规律对这些自杀结果的近端风险的影响。最后我们 将用计算精神病学的新进展来补充传统的统计方法。这项建议 是创新的，因为它具有独特的统计学功效，可以阐明近端风险的时间动态， 自杀事件，以及利用新技术来联合收割机多种方法（即，行为的，生理的， 神经认知和自我报告测量），包括三个连续的动态评估数据流， 跨越多个分析单元（即，心理社会和生理压力）。该应用程序可以识别 在风险升高期间监测患者的重要变量，并确定具体和易处理的 治疗目标，从而为未来的临床干预工作提供方向。

While other leading causes of death have seen significant declines, suicide rates in youth have increased. It is the second leading cause of death among adolescents, and hospital encounters for suicide in this age group have doubled over the last decade. In 50 years of research, the field has focused almost exclusively on long- term risk for suicidal outcomes, with an average follow-up period of 10 years. Indeed, there has been only one study of short-term risk for suicidal behavior in adults and none in adolescents. This is notable because long- term risk factors tend to be poor predictors of short-term risk. Consequently, the current evidence base for healthcare providers' decisions in determining proximal risk and the corresponding appropriate clinical response is quite limited. The low base rate of suicidal behavior in adolescents is particularly challenging for studying short-term risk for this outcome, and this in large part accounts for the absence of research in this area. To overcome this difficulty, large samples drawn from high-risk populations are necessary. In the current proposal, we are uniquely positioned to address this difficulty. That is, we will leverage secondary data from one of our current studies of suicide risk in adolescent psychiatric inpatients by pooling these data with data collected on 200 new patients for a final sample of 400. Additionally, recent developments in ambulatory assessment technologies offer novel opportunities for elucidating the temporal dynamics of proximal suicidal risk, thereby addressing the elusive question of not only whether an individual is at risk for engaging in suicidal behavior in the near future but when they may be most at risk. The current application will evaluate arousal (in the form of stress and sleep disturbance) in relation to proximal risk for suicidal outcomes using ambulatory assessment measures. Specifically, employing ecological momentary assessment, a mobile biosensor, and actigraphy, we aim to evaluate the interrelation of time-varying stress (at psychosocial and physiological levels) and sleep irregularity in the temporal dynamics of risk for suicidal ideation and events (suicide attempts and intensive clinical care for acute suicidality) over one month post-discharge. Given the prefrontal cortex's involvement in regulating arousal, we will also evaluate whether executive functioning at baseline moderates the effects of time-varying stress and sleep irregularity on proximal risk for these suicidal outcomes. Finally, we will supplement traditional statistical methods with novel advances in computational psychiatry. This proposal is innovative by being uniquely powered statistically to clarify the temporal dynamics of proximal risk for suicidal events, and leveraging new technologies to combine multiple methods (i.e., behavioral, physiological, neurocognitive, and self-report measures), including three continuous streams of ambulatory assessment data, across multiple units of analysis (i.e., psychosocial and physiological stress). This application may identify important variables for monitoring of patients during periods of elevated risk and identify specific and tractable treatment targets, thus providing directions for future clinical intervention efforts.