Approximating Mechanisms of Suicide Risk to Innovate Interventions for Mid-to-Late-Life Veterans

目前为期两年的职业发展奖（CDA-1）提案旨在为迈克尔博士做好准备

The current 2-year career development award (CDA-1) proposal is designed to prepare Dr. Michael Ruderman, a VA Psychiatrist with foundational knowledge of advanced research methods, for a career in VA conducting research as a psychiatrist scientist who will advance innovation in suicide prevention and intervention strategies—identifying and targeting causal mechanisms for suicide that are amenable for intervention. Dr. Ruderman will accomplish this goal through the pursuit and completion of training activities, support from an expert mentoring team, and completion of a research project aimed at bridging the gap between causal inference research methods and clinical knowledge to inform suicide interventions. The CDA-1 project will ultimately generate pilot information about causal factors for suicide risk with refinement based on expert elicitation for Dr. Ruderman’s submission of a CDA-2 application. Dr. Ruderman’s proposed CDA-1 project supports VA’s top clinical priority—Preventing suicide. Moreover, this proposal is directly aligned with VA’s mandate to prioritize research that can help develop targeted suicide interventions by finding out why certain Veterans are at risk of suicide. Despite VA’s strong predictive analytics for stratifying Veterans at risk for suicide, the mechanisms leading to suicide are poorly understood. This lack of knowledge has impeded the innovation of targeted and effective interventions available. National suicide research agendas urge investigators to leverage existing data and determine potential causal targets that could define or develop effective suicide interventions. However, few large-scale databases exist that would have the capacity to harmonize and link to the right breadth and depth of information to successfully detect causal targets for a rare (yet, profound) outcome like suicide. Thus, this CDA-1 proposed research leverages Dr. Amy Byers’ (primary mentor on the CDA-1) CSR&D Merit award project (CX001119), which uniquely formed a longitudinal cohort of 5 million Veterans aged 50 years and older including, currently, nearly 12,000 suicide deaths and data on demographics, inpatient, outpatient, medications, labs, and morbidity. The CDA-1 project will expand upon Dr. Byers’ research on late-life suicide risk looking at prognostic factors and fill a significant gap in the field, causal inference, complementing predictive analytics in suicide risk research at VA. Furthermore, focusing on mid-to-late-life Veterans is ideal because it supplies targeted information in this understudied and highly vulnerable group, who have the highest number of lives lost to suicide (~70% of all Veteran suicide deaths), as well as make up over 70% of the Veteran population. Discovering candidates from large secondary data requires an approach that can extract causal information efficiently while also prioritizing likelihood of clinical utility. Data-driven causal methods have the potential to do this, but only if such methods are tightly linked with existing clinical and other scientific knowledge. Therefore, we propose an approach where we: first (Aim 1) utilize causal discovery techniques to identify preliminary causal candidates for suicide in Veterans aged 50 years and older; and, then, second (Aim 2) develop a protocol to elicit clinical expertise on potential mechanisms of suicide, which will provide necessary pilot information for a CDA-2 application. Such a biphasic approach ensures expert knowledge is integrated with computational analysis to maximize likelihood of clinical utility for suicide prevention. To this end, the aims and training of this 2-year CDA-1 will prepare Dr. Michael Ruderman to submit a CDA-2 application—clearing a path toward an independent research program as a computational psychiatrist, bridging methods to institute actionable change, reducing suicide risk for Veterans, and empowering their providers.