Towards a reliable and valid assessment of preteen suicidal thoughts and behavior

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Project Summary The preteen years are a critical period in which to study the development of suicidal thoughts and behavior (STB). During this period, youth experience changes in emotion regulation and develop cognitive capacities that include an emerging understanding of the permanence of death, which in turn affect the expression of STB. However, as noted in the 2021 NIMH- Sponsored Research Round Table Series: Risk, Resilience, and Trajectories in Preteen Suicide, research on preteen STB has been hindered by the field’s failure to focus on an accurate, and thorough, assessment of STB in this age group.This application seeks to develop and test a comprehensive approach to the assessment of preteen STB that includes child and parent/guardian self-report, clinician interviews, an implicit association test, a death understanding interview, and observational measures. In order to address this question, this application will examine both concurrent and predictive validity of the assessment approach in preteens receiving intensive psychiatric services (inpatient or partial hospitalization) who have a range of internalizing and externalizing symptoms, as well as a range of STB. We will recruit 360 preteens at Bradley Hospital/Brown Medical School and the Johns Hopkins School of Medicine, ensuring a diverse sample of children. In addition to refining the assessment of preteen STB, we will also: 1) conduct a thorough clinical assessment of related symptomatology to better inform clinical practice, and 2) examine mechanisms hypothesized to underlie preteen STB, using an RDoC-informed approach. We will also examine which co- occurring symptoms and mechanisms significantly improve predictive validity for adverse clinical STB outcomes above that of the STB assessment alone. This assessment approach is innovative in that it is the first study to develop a multi-modal, multi-informant assessment approach for preteen STB including use of real-time observational strategies, as well as an implicit association test. This is significant because we are studying the most high-risk population of preteens with STB and we will be able to delineate mechanisms related to preteen STB. This work addresses: NIMH Strategic Objective 2.1.B “Characterize the emergence and progression of mental illnesses”, 2.2.A “Determining early risk and protective factors and related mechanisms”, and 2.2.B“Developing reliable and robust biomarkers and assessment tools to predict illness onset, and course, across diverse populations”.