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

基本信息

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
项目类别：
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

项目摘要

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.

项目摘要/摘要自杀构想和行为正在美国越来越多。尤其是关于自杀的风险，在出院后的高风险期间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对远端/横断面自杀危险因素的过度依赖造成的而不是强调近端风险因素（动态认知，情感和行为自杀前几天，小时和几分钟发生的经历）。拟议的研究基于我们团队在数字表型和自杀风险的生态有效模型方面的现有基础架构和专业知识。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）如何破坏）近端风险因素相互作用以影响自杀行为的自杀念头和会议风险，特别是在住院后的高风险时期。我们将招募和跟进240个精神病学在五年的研究期内，住院病人因自杀念头或行为而住院。参与者将完成基线评估，包括临床访谈，基于实验室的行为评估和自我报告与自杀相关的远端风险因素。在住院期间，参与者将开始完成生态情感，认知，行为和社会/环境环境的瞬时评估（EMA）。下列的出院，参与者将在基线时继续对4周的EMA监测，并再次进行两个3周的EMA 在3个月和6个月的随访评估中进行“爆发”。在每个EMA监控期间，我们将收集数字使用可穿戴设备和智能手机传感器的表型数据（例如睡眠，位置，活动水平/运动水平/运动）。我们将在我们的实验室中进行3个月和6个月的随访评估，以重新管理实验室的行为评估并收集结果数据，包括自杀构想，自杀行为和重新占领。提议研究旨在确定自杀的近端风险因素，并使用密集的纵向方法来表征受影响和上下文近端风险因素之间的关系，同时还研究了远端风险因素如何调节近端风险因素之间的关系以及近端风险因素与自杀构想之间的关系和行为。我们将在排出精神病学之前和之后检查这些关系住院。这项研究的结果有可能大大增强我们对自杀的理解现象学存在于现实世界中，尤其是在精神科之后的高风险时期住院，有可能提高我们预测，预防和最终治疗自杀思想的能力以及使用传统和技术增强干预措施的行为。