Dynamic Regulatory Processes in the Transition from Suicidal Ideation to Action: The Roles of Cognitive Control, Emotion-Related Impulsivity, and Sleep in the Context of Negative Affective Experiences

项目摘要 很少有NIMH资助的研究检查了自杀意念短期内的人内变化的贡献者 和自杀行为的几率我们建议使用多模式评估（自我报告，行为，活动记录） 捕捉与自杀风险相关的几个RDoC领域的变化。在从构想到行动的框架内，我们 区分自杀想法的急性风险因素与那些有助于从自杀转变的因素。 从观念到行为我们将在样本中使用28天的密集纵向设计来测试我们的理论模型 自杀的成年人离开住院的行为健康护理，这是一个自杀风险特别高的人群。 目的1：检验一组跨理论的危险因素作为自杀倾向个体内变化的近端预测因子。 思想使用生态瞬时评估，我们将收集七个假设的重复测量值， 构思风险因素，以及构思的维度测量，以建模滞后关系， 情感风险因素和随后的想法。我们希望每个情感风险因素都表现出积极的影响， 与随后的自杀意念增加相关，并且这些风险因素将在日常生活中同时发生 因此，它们最好被概念化为捕捉情感痛苦（心理疼痛）的单个潜在结构。 目的2：检验自我报告和抑制控制的行为测量作为自杀行为的危险因素。我们 预期那些在基线时报告更大的情绪相关冲动， 在使用负效价刺激的行为任务中，反应抑制将具有更高的自杀企图几率 超过后续行动。使用一种新的移动的适应的抑制控制任务期间的生态瞬间 评估期间，我们预计，在抑制控制的人内递减将在人内 在有自杀想法的人中，自杀企图的可能性增加。 目标3：评估客观测量的睡眠时间作为自杀想法和自杀倾向的近端风险因素 自杀行为使用腕戴式腕动仪，我们将研究睡眠时间有多短， 参与者的平均睡眠与第二天的想法和尝试有关。我们认为短时间的睡眠 预测自杀想法的增加，以及自杀企图的可能性增加， 控制自杀意念最后，我们将测试一个探索性的假设，即睡眠自杀企图 这种关联可以用消极情绪背景下与睡眠相关的抑制控制能力下降来解释。 这项研究的结果将阐明可修改的情感，认知和生理目标， 移动的干预措施来预防自杀。

Project Abstract Few NIMH-funded studies have examined contributors to short-term, within-person changes in suicidal ideation and odds of suicidal behavior. We propose to use multi-modal assessments (self-report, behavior, actigraphy) to capture changes in several RDoC domains relevant to suicide risk. In an ideation-to-action framework, we differentiate acute risk factors for suicidal thoughts from those that contribute to the transition from suicidal ideation to behavior. We will test our theoretical model using a 28-day intensive longitudinal design in a sample of suicidal adults leaving inpatient behavioral health care, a population at particularly high risk for suicide. Aim 1: Examine a set of transtheoretical risk factors as proximal predictors of within-person changes in suicidal thoughts. Using ecological momentary assessment, we will gather repeated measures of seven hypothesized ideation risk factors, as well as a dimensional measure of ideation, to model lagged relationships between affective risk factors and subsequent ideation. We expect that each affective risk factor will show a positive association with subsequent increases in suicidal ideation, and that these risk factors will co-occur in daily life such that they are best conceptualized as a single latent construct capturing emotional suffering (psychache). Aim 2: Test self-report and behavioral measures of inhibitory control as risk factors for suicidal behavior. We expect that participants who, at baseline, report greater emotion-related impulsivity, and who show impaired response inhibition in a behavioral task using negative valence stimuli, will have higher odds of suicide attempt over follow-up. Using a novel mobile adaptation of an inhibitory control task during the ecological momentary assessment period, we expect that within-person decrements in inhibitory control will precede within-person increases in likelihood of suicide attempt among individuals thinking of suicide. Aim 3: Evaluate objectively measured sleep duration as a proximal risk factor for both suicidal ideation and suicidal behavior. Using wrist-worn actigraphy devices, we will examine how short sleep duration, compared to participants’ average sleep, relates to next-day ideation and attempts. We expect that short sleep duration will predict within-person increases in suicidal thoughts, as well as increased likelihood of suicide attempts, controlling for suicidal ideation. Finally, we will test an exploratory hypothesis, that the sleep-suicide attempt association is explained by sleep-related decreases in inhibitory control in the context of negative affect. Findings from this study will elucidate modifiable affective, cognitive, and physiological targets for just-in-time, mobile interventions to prevent suicide.