Neurocognitive characteristics of short-term risk for suicidal behavior in adolescents

摘要 自杀是青少年死亡的第二大原因。事实上，全国自杀率 在过去的15年里增加了24%，儿童和青少年自杀的医院就诊人数增加了一倍， 过去十年尽管大量的研究致力于确定自杀的危险因素， 行为，迄今为止的研究集中在长期风险，平均随访间隔为10年。 事实上，目前还没有关于青少年这种行为的短期风险的研究。弥补这一差距， 自杀研究很重要，因为长期风险因素不能很好地预测短期风险。因此，我们认为， 澄清与自杀行为短期风险相关的过程对于推进我们的知识很重要 从谁有风险到他们什么时候最有风险神经认知功能已被确定为具有 作为短期风险的指标。虽然神经认知功能的核心成分 与自杀有关，对青少年自杀企图的短期纵向研究， 缺乏此外，虽然传统的统计方法已被用来模拟这些神经认知 过程，最近的发展，在计算精神病学涉及认知过程模型可能更多 真实地反映了这些过程。此外，计算精神病学允许同时 以产生复杂预测模型的方式考虑多个变量， 基本上上级于从传统统计方法得到的那些。我们的长期目标是改善 检测短期风险，并确定临床干预的潜在可修改目标。为此， 本申请的目的是评估神经认知障碍的短期风险的候选神经认知标志物。 自杀企图和自杀事件（即，一个月以上的随访）在一个样本的青少年精神病 住院患者，补充传统的统计方法与计算精神病学的新进展。 重要的是，缺乏研究调查自杀行为短期风险的主要原因是， 青少年的一个问题是，这种行为的基础率很低，这对可行性构成了重大挑战。大 需要从高风险或临床严重人群中抽取样本来克服这一障碍。我们 通过利用我们当前研究的现有数据，我们处于独特的地位，可以应对这一挑战。我们一起 我们目前的数据是从200名新患者中收集的数据，最终样本为414人。这个应用是创新的 通过：（一）是第一个统计学上有把握的研究自杀企图的风险因素超过一个月;（二）具有 一个全面的神经认知电池，包括一般和自我伤害特定的神经认知 过程;和（iii）应用新的计算精神病学方法来模拟神经认知指数， 短期风险。此应用程序解决了NIMH/国家计划中的理想目标1的研究目标 预防自杀行动联盟的预防自杀优先研究议程：确定 与自杀风险相关的神经精神病学特征和认知功能障碍。

Abstract Suicide is the second leading cause of death among adolescents. In fact, the national suicide rate has increased 24% over the last 15 years, and hospital visits for child and adolescent suicidality have doubled in the last 10 years. Although considerable research has been devoted to identifying risk factors for suicidal behavior, the research to date has focused on long-term risk, with average follow-up intervals of 10 years. Indeed, there are currently no studies of short-term risk for this behavior in adolescents. Addressing this gap in suicide research is important because long-term risk factors are poor predictors of short-term risk. Therefore, clarifying processes relevant to short-term risk for suicidal behavior is important for advancing our knowledge from who is at risk to when they are most at risk. Neurocognitive function has been identified as having particular potential as indicators of short-term risk. Although core components of neurocognitive function have been associated with suicidality, short-term longitudinal studies of adolescent suicide attempts, are notably lacking. Additionally, although traditional statistical methods have been used to model these neurocognitive processes, recent developments in computational psychiatry involving cognitive process models may more realistically reflect these processes. Furthermore, computational psychiatry allows for simultaneous consideration of multiple variables in a manner that produces a complex prediction model that is often substantially superior to those derived from traditional statistical approaches. Our long-term goal is to improve detection of short-term risk and to identify potential modifiable targets for clinical intervention. Toward this end, the objective of the current application is to evaluate candidate neurocognitive markers of short-term risk for suicide attempts and suicidal events (i.e., over one-month follow-up) in a sample of adolescent psychiatric inpatients, supplementing traditional statistical methods with novel advances in computational psychiatry. Importantly, the primary reason for the absence of studies investigating short-term risk for suicidal behavior in adolescents is that the low base rate for this behavior poses a significant challenge for feasibility. Large samples drawn from high-risk or clinically severe populations are required to overcome this obstacle. We are uniquely positioned to address this challenge by leveraging existing data from our current studies. We will pool our current data with data collected on 200 new patients for a final sample of 414. This application is innovative by: (i) being the first statistically powered study of risk factors for suicide attempts over one month; (ii) featuring a comprehensive neurocognitive battery that includes general and self-harm-specific neurocognitive processes; and (iii) applying novel computational psychiatry approaches to modelling neurocognitive indices of short-term risk. This application addresses the research objectives of Aspirational Goal 1 in the NIMH/National Action Alliance for Suicide Prevention's Prioritized Research Agenda for Suicide Prevention: identifying neuropsychiatric profiles and cognitive dysfunction associated with suicide risk.