Nocturnal wakefulness, cognitive control, and suicidal urges: A prospective evaluation of variance during residential treatment

项目摘要/摘要 夜间觉醒和认知控制的改变都与自杀念头和 横断面研究中的行为，但考虑到这项工作的方法论限制，这些 基因改变在近端自杀风险中的作用尚不清楚。我们建议对退伍军人进行密集的评估 从创伤后应激障碍(PTSD)住院单元招募失眠和自杀意念的探索 夜间觉醒、认知控制和自杀风险之间的联系。我们还预计， 观察到的夜间觉醒、认知控制和自杀意念之间的联系将不会 仅限于创伤后应激障碍，但创伤后应激障碍是测试这些关联的理想人群 精神分裂症患者夜间觉醒、认知控制和自杀意念障碍的重要性 这是一种混乱。目标是： 目的1：前瞻性评估夜间觉醒与自杀意念之间的关系 患有创伤后应激障碍的退伍军人。假设1：夜间清醒的时间更长，以醒着的分钟数为指标 从晚上11点到上午7点，根据床垫传感器条上的移动，将与次日更高相关 自杀意念、创伤后应激障碍和抑郁严重程度、基线睡眠障碍的影响 症状和人口统计变量(如年龄、性别、种族/族裔)。 目的2：前瞻性地评估认知控制与自杀意念之间的关系。 创伤后应激障碍。假设2：认知控制能力降低(每天的认知任务表现，在早上几小时完成 以及在夜间醒来时)将与更高的后续自杀意念相关联，超过 创伤后应激障碍和抑郁严重程度、基线认知控制表现和人口统计变量的影响。 目的3：评估认知控制作为夜间睡眠之间联系的中介的证据。 患有创伤后应激障碍的退伍军人的觉醒和自杀意念。假设3：两者之间的关联 夜间觉醒和自杀意念将部分地被认知控制能力降低所调节。 该R21将支持后续的R01项目，以测试自杀意念分类的算法 以及基于夜间觉醒和认知控制变化的行为，利用由此产生的方法 建议以及更多层次的分析(例如，神经激活)。我们对建议的结果进行了规划 该项目将为新的应用研究提供信息，这些应用研究将直接利用我们的成果来开发新的生态系统 旨在减轻近端自杀风险的瞬时干预策略。

Project Summary/Abstract Alterations in nocturnal wakefulness and cognitive control are both associated with suicidal thoughts and behaviors in cross-sectional research, but given the methodological limitations of this work, the role that these alterations play in proximal suicide risk remains unclear. We propose to intensively assess veterans with insomnia and suicidal ideation recruited from a posttraumatic stress disorder (PTSD) residential unit to explore the associations among nocturnal wakefulness, cognitive control, and suicide risk. We also anticipate that the associations observed between nocturnal wakefulness, cognitive control, and suicidal ideation will not be exclusive to PTSD, but that PTSD serves as an ideal population in which to test these associations given the importance of disturbances in nocturnal wakefulness, cognitive control, and suicidal ideation among patients with the disorder. The aims are: Aim 1: To evaluate associations between nocturnal wakefulness and suicide ideation prospectively, in veterans with PTSD. Hypothesis 1: Longer duration of nocturnal wakefulness, as indexed by minutes awake from 11 PM – 7 AM based on movement on the mattress sensor strip, will be associated with higher next-day suicidal ideation, above and beyond the influence of PTSD and depression severity, baseline sleep disorder symptoms, and demographic variables (e.g., age, gender, race/ethnicity). Aim 2: To evaluate associations between cognitive control and suicidal ideation prospectively, in veterans with PTSD. Hypothesis 2: Reduced cognitive control (daily cognitive task performance, completed in the morning hours and when awake at night) will be associated with higher subsequent suicidal ideation, above and beyond the influence of PTSD and depression severity, baseline cognitive control performance, and demographic variables. Aim 3: To evaluate evidence for cognitive control as a mediator of the association between nocturnal wakefulness and suicidal ideation prospectively, in veterans with PTSD. Hypothesis 3: The association between nocturnal wakefulness and suicidal ideation will be partially mediated by reduced cognitive control performance. This R21 will support a subsequent R01 project to test an algorithm for the classification of suicidal ideation and behavior based on alterations in nocturnal wakefulness and cognitive control, utilizing methods from this proposal as well as additional levels of analysis (e.g., neural activation). We plan for the results of the proposed project to inform a new line of applied research that will directly utilize our results to develop new ecological momentary intervention strategies aimed at mitigating proximal suicide risk.