Testing a Dyadic Model of Proximal Suicide Risk in Young Adult Romantic Couples

项目摘要/摘要 自杀是导致年轻人死亡的主要原因，特别是在那些患有边缘人格障碍的人中 (Bpd)，其中高达10%的人死于自杀。BPD的特点是关系威胁敏感(例如， 对感觉到的拒绝的高反应性)，这预示着恋爱关系中的冲突，而且通常是立即发生的 自杀相关事件(自杀意念、自杀相关沟通、准备行为、 尝试)。然而，尽管大多数自杀理论都明确强调了人际关系因素的重要性， 自杀研究几乎完全集中在有自杀倾向的个体上，而没有考虑到二元性 有自杀倾向的人所处的环境。因此，该项目的首要目标是识别并元 高自杀风险青年恋爱关系中的人际关系机制加剧和 保持自杀风险。我们将测试自杀风险的二元模型，在该模型中，情绪的多模式指数 在二元冲突期间的反应性和有问题的沟通功能，以增加和维持SRE的风险 随着时间的推移。为了实现这一目标，我们将招募168对浪漫情侣(年龄在18-35岁之间)，其中至少有一人 最近有过自发性脑脊髓炎，因此自杀风险很高。我们将对样品进行分层，以确保全面的 关系威胁敏感度和BPD严重性，这些远端风险因素将被视为预测因素和 所有假想效果的主持人。参与者将完成一项基线实验室评估，包括 基于实验室的二元冲突讨论任务和为期14天的生态瞬时评估(EMA)协议 有连续的动态心理生理学和简短的录音样本。此外，对偶数将 在4个月、8个月和12个月后完成对自发性精神分裂症和心理社会功能的三次后续评估 基线。我们的具体目标是：1)考察情绪反应和情绪反应之间的相互依存关系 在有自杀风险的浪漫夫妻中有问题的沟通；2)调查个人内部和 情绪反应和有问题的沟通的二元模式预测近端的增加(随着时间的推移， 天)在SRE；以及3)评估SRE后的情绪反应和沟通问题 加强未来自杀性精神分裂症的功能，并预测自杀风险和心理社会功能恶化的轨迹。 这项研究的结果将导致改进评估工具，确定新的基于夫妇的干预措施 目标，并为制定以证据为基础的战略提供信息，以降低自杀风险和心理社会 易受伤害个体的损害。

PROJECT SUMMARY/ABSTRACT Suicide is a leading cause of death in young adults, especially among those with borderline personality disorder (BPD), of whom up to 10% of whom die by suicide. BPD is hallmarked by relationship threat sensitivity (e.g., hyperreactivity to perceived rejection) which predicts conflict in romantic relationships, and often immediately precedes suicide-related events (SREs; suicide ideation, suicide-related communication, preparatory behaviors, attempts). While most theories of suicide explicitly underscore the importance of relationship factors however, suicide research has focused almost exclusively on the suicidal individual and failed to consider the dyadic context in which the suicidal individual exists. Thus, the overarching goal of this project is to identify dyadic interpersonal mechanisms within romantic relationships of high-suicide-risk young adults that exacerbate and maintain suicide risk. We will test a dyadic model of suicide risk whereby multimodal indices of emotional reactivity and problematic communication during dyadic conflict function to increase and maintain risk for SREs over time. To achieve this goal, we will recruit 168 romantic couples (ages 18-35) in which at least one member has had recent SREs and is thus at high risk for suicide. We will stratify the sample to ensure a full range of relationship threat sensitivity and BPD severity, and these distal risk factors will be examined as predictors and moderators of all hypothesized effects. Participants will complete a baseline laboratory assessment including a laboratory-based dyadic conflict discussion task and a 14-day ecological momentary assessment (EMA) protocol with continuous ambulatory psychophysiology and brief samples of audio recordings. Additionally, dyads will complete three follow-up assessments of SREs and psychosocial functioning at 4-, 8- and 12-months post- baseline. Our specific aims are to: 1) Examine interdependent associations between emotional reactivity and problematic communication in romantic dyads with suicide risk; 2) Investigate whether within-individual and dyadic patterns of emotional reactivity and problematic communication predict proximal increases (over hours, days) in SREs; and 3) Assess whether emotional reactivity and problematic communication following SREs functions to reinforce future SREs and predict worsening trajectories of suicide risk and psychosocial functioning. Findings from this study will lead to improved assessment tools, identify novel couples-based intervention targets, and inform the development of evidence-based strategies to reduce suicide risk and psychosocial impairment in vulnerable individuals.