Suicidality in Young Children: Social and Cognitive Developmental Markers of Risk and Resiliency

项目摘要 儿童自杀是一个紧迫且未得到充分研究的公共卫生问题。年轻人的自杀率增加了两倍 近年来，关于自杀念头和行为的早期出现或发展，人们知之甚少。 (是/某人)。自杀念头(例如，想死，表达自杀的愿望)和行为(例如，窒息 早在学龄前阶段就已被确认为早发性抑郁症。然而， 未患抑郁症的幼儿是否以及如何表现出自杀倾向尚不清楚。重要的是，早期自杀仍然存在 稳定到学龄期，并为后来的精神病理学提供风险，表明这种情况的持久影响和连续性 早期表现。与NIMH战略目标2保持一致，即“绘制精神疾病轨迹图以 确定何时、何地以及如何进行干预，“此K01应用程序的首要目标是了解 为了识别高危青少年并告知预防措施而出现自杀行为的发展背景 干预努力。拟议的研究将解决一些关键问题，以了解 儿童早期自杀的发展，包括SI/SB在这个早期是如何表达的， 发展对自杀的理解，如果SI/SB儿童表现出缺乏乐观和/或悲观， 以及患有SI/SB的儿童如何处理同伴的接受和拒绝。各种措施，包括儿童 将实施访谈和叙述方法、行为任务和事件相关电位(ERPs 对于来自不同种族和社会经济背景的三组4至7岁的儿童：1)有病史的儿童 2)有精神病理或有精神疾病风险但无SI/SB病史的儿童，以及3)低风险健康儿童。 将患有或有精神病理风险的无SI/SB病史的儿童包括在内将解决这一特殊性 与抑郁症状和其他形式的精神病理有关的自杀风险因素。这种方法 有可能确定幼儿自杀的跨诊断危险因素。包括低风险的 健康的儿童将帮助我们理解典型和非典型的自杀轨迹 提供指导，指导临床如何以及何时处理儿童时期的自杀表现 担忧。这将是第一项针对如此年幼的SI/SB儿童的研究，旨在 调查SI/SB的风险和复原力的发展前因。自杀研究和预防是一项 NIMH的高优先级研究领域以及所描述的研究和培训活动将使应聘者 制定一项独立的研究计划，解决儿童自杀率上升的问题。具体来说， 拟议项目的实施将为候选人提供自杀研究方面的培训和专业知识 以及预防、儿童精神病理学和事件相关电位技术。丰富的培训环境和多学科的 详细介绍了每个领域的导师团队。来自该项目的数据将用于计划中的R01到更多 深入调查种族和/或社会文化差异的危险因素和发展轨迹的早期 自杀性发作。

Project Summary Suicidality in children is a pressing and understudied public health concern. Rates of suicide in youth have tripled in recent years, yet little is known about the early emergence or development of suicidal ideation and behaviors (SI/SB). Suicidal ideation (e.g., wishing to be dead, expressing desire to kill oneself) and behaviors (e.g., choking oneself) have been identified as early as the preschool period in the context of early-onset depression. However, if and how suicidality presents in non-depressed young children is unknown. Importantly, early suicidality remains stable into school-age and confers risk for later psychopathology, suggesting lasting impact and continuity of this early manifestation. Consistent with the NIMH Strategic Objective 2, to “chart mental illness trajectories to determine when, where, and how to intervene,” the overarching aim of this K01 application is to understand the developmental contexts in which suicidality emerges in order to identify at-risk youth and to inform preventative intervention efforts. The proposed study will address a number of questions central to understanding the development of suicidality in early childhood including how SI/SB is expressed at this early age, the normative development of the understanding of suicide, if children with SI/SB exhibit lack of optimism and/or pessimism, and how children with SI/SB process peer acceptance and rejection. A variety of measures, including child interview and narrative approaches, behavioral tasks, and event related potentials (ERPs) will be administered to three groups of 4- to 7-year-olds from diverse racial and socioeconomic backgrounds: 1) children with a history of SI/SB, 2) children with or at risk for psychopathology but no history of SI/SB, and 3) low-risk healthy children. The inclusion of children with or at risk for psychopathology with no history of SI/SB will address the specificity of risk factors for suicidality relative to depressive symptoms and other forms of psychopathology. This approach has the potential to identify transdiagnostic risk-factors of suicidality in young children. The inclusion of low-risk healthy children will inform our understanding of typical and atypical trajectories of suicide understanding and provide guidance regarding how and when to address expressions of suicidality in childhood as a clinical concern. This will be the first study of children this young with SI/SB to be targeted for a study designed to investigate the developmental antecedents of risk and resilience for SI/SB. Suicide research and prevention is a high priority research area for NIMH and the described research and training activities will enable the candidate to develop an independent research program that addresses the rising rates of childhood suicidality. Specifically, the execution of the proposed project will provide the candidate with training and expertise in suicide research and prevention, child psychopathology, and ERP techniques. A rich training environment and a multidisciplinary team of mentors in each of these areas is detailed. Data from this project will be used in a planned R01 to more deeply investigate racial and/or sociocultural differences in risk factors and developmental trajectories of early- onset suicidality.