Ecological Assessment of Proximal Risk Factors for Suicide During Care Transitions

护理过渡期间自杀近端危险因素的生态评估

• 批准号: 10583908
• 负责人: Michael F Armey
• 金额: $ 75.62万
• 依托单位: BUTLER HOSPITAL (PROVIDENCE, RI)
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2027-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10583908
• 关键词: Acute; Affect; Affective; American; Back; Behavior; Behavior assessment; Behavioral; Caring; Cellular Phone; Clinical; Cognition; Cognitive; Communities; Conflict (Psychology); Data; Data Collection; Development; Diagnostic; Distal; Ecological momentary assessment; Emotions; Enhancement Technology; Environment; Face; Feeling suicidal; Future; Hospitalization; Hour; Individual; Infrastructure; Inpatients; Interruption; Intervention; Interview; Laboratories; Life; Link; Location; Measurement; Measures; Methods; Modeling; Monitor; Movement; Network-based; Outcome; Outcome Study; Participant; Patient Self-Report; Patients; Pattern; Persons; Phenotype; Play; Prevention; Process; Public Health; Questionnaires; Research; Risk; Risk Assessment; Risk Behaviors; Risk Factors; Sampling; Sleep; Sleep disturbances; Social Interaction; Suicide; Suicide attempt; Suicide prevention; Thinking; Time; Typology; United States; contextual factors; digital; experience; follow up assessment; follow-up; high risk; hospital readmission; improved; in vivo; indexing; insight; multimodality; negative affect; participant observation; pediatric trauma; phenomenological models; phenotypic data; prevent; primary outcome; recruit; response; secondary outcome; sensor; social; suicidal; suicidal behavior; suicidal morbidity; suicidal risk; suicide model; suicide rate; wearable device

Project Summary/Abstract Suicidal ideation and behavior are growing public health problems in the United States. This is particularly concerning during the high-risk period following discharge from psychiatric hospitalization when risk for suicide is among the highest rates observed. Unfortunately, our current ability to predict suicide is only slightly above chance. This poor predictive ability may be due to an overreliance on distal/cross-sectional suicide risk factors alone, rather than an emphasis on proximal risk factors (the dynamic cognitive, affective, and behavioral experiences occurring in the days, hours, and minutes prior to suicide). The proposed study builds upon our team's existing infrastructure and expertise in digital phenotyping and ecologically valid models of suicide risk. We will examine how affective (e.g., negative affect) and contextual (e.g., social interactions, cognitions, & sleep disruption) proximal risk factors interact to influence suicidal ideation and confer risk for suicidal behavior, particularly during the high-risk period following hospitalization. We will recruit and follow-up with 240 psychiatric inpatients hospitalized for suicidal ideation or behavior over a five-year study period. Participants will complete baseline assessments including clinical interviews, laboratory-based behavioral assessments, and self-reports of distal risk factors associated with suicide. During hospitalization, participants will begin completing ecological momentary assessments (EMAs) of affect, cognition, behavior, and social/environmental context. Following discharge, participants will continue EMA monitoring for 4-weeks at baseline and again for two 3-week EMA “bursts” at 3- and 6-month follow-up assessments. During each EMA monitoring period, we will collect digital phenotyping data (e.g., sleep, location, activity level/movement) using wearables and smartphone sensors. We will conduct 3- and 6-month follow-up assessments in our lab to re-administer lab-based behavioral assessments and collect outcome data including suicidal ideation, suicidal behavior, and re-hospitalization. The proposed study aims to identify proximal risk factors for suicide and use intensive longitudinal methods to characterize the relationships among affective and contextual proximal risk factors while also examining how distal risk factors moderate the relationships among proximal risk factors and between proximal risk factors and suicidal ideation and behavior. We will examine these relationships both before and after discharge from psychiatric hospitalization. The results of this study have the potential to substantially enhance our understanding of suicide phenomenology as it exists in the real world, particularly across the high-risk period following psychiatric hospitalization, with the potential to improve our ability to predict, prevent, and ultimately treat suicidal thoughts and behaviors using traditional and technology-enhanced interventions.

项目总结/摘要 自杀意念和行为是美国日益严重的公共卫生问题。这是特别 关于在精神病住院治疗出院后的高风险期， 是观察到的最高比率之一。不幸的是，我们目前预测自杀的能力仅略高于 机会这种预测能力差可能是由于过度依赖于远端/横截面自杀风险因素 单独，而不是强调近端风险因素（动态认知，情感和行为 在自杀前的几天、几小时和几分钟内发生的经历）。这项研究的基础是我们的 团队现有的基础设施和在数字表型和自杀风险的生态有效模型方面的专业知识。 我们将研究情感（例如，负面影响）和上下文（例如，社会互动、认知和睡眠 破坏）近端风险因素相互作用以影响自杀意念并赋予自杀行为的风险， 特别是在住院后的高危期。我们将招募240名精神病患者， 在五年的研究期间，因自杀意念或行为住院的住院患者。参与者将完成 基线评估，包括临床访谈、实验室行为评估和自我报告 与自杀相关的远端风险因素。住院期间，受试者将开始完成生态学检查 情感、认知、行为和社会/环境背景的瞬时评估（EMA）。以下 出院后，受试者将在基线时继续EMA监测4周，并再次进行两次为期3周的EMA监测 3个月和6个月随访评估时的"爆发"。在每个EMA监测期间，我们将收集数字 表型数据（例如，睡眠、位置、活动水平/运动）。我们 将在我们的实验室进行3个月和6个月的随访评估，以重新进行基于实验室的行为评估 并收集结果数据，包括自杀意念、自杀行为和再住院。拟议 这项研究旨在确定自杀的近端危险因素，并使用密集的纵向方法来描述自杀的特征。 情感和背景近端风险因素之间的关系，同时也研究了远端风险因素 调节近端危险因素之间以及近端危险因素与自杀意念之间的关系 和行为。我们将在精神科出院前后检查这些关系。 住院这项研究的结果有可能大大提高我们对自杀的理解 现象学，因为它存在于真实的世界中，特别是在精神疾病后的高风险时期， 住院治疗，有可能提高我们预测，预防和最终治疗自杀想法的能力 以及使用传统和技术强化干预的行为。