Clarifying proximal mechanisms linking interpersonal stressors to suicidal behavior in youth: A multi-informant real-time monitoring study

项目摘要 自杀是青少年死亡的第二大原因，令人震惊的是，自杀率继续上升。 在过去的十年中增加。由于目前缺乏经验支持的心理社会干预， 青少年自杀行为，有很大的需要，以确定潜在的风险，这一结果的过程。 人际负性生活事件（NLE）与自杀行为的短期风险有关（即，自杀 尝试和死亡）。然而，目前尚不清楚这些人际NLE如何或为什么会带来风险。 理解人际NLE和自杀行为之间联系的调节因子和机制 是至关重要的，以便确定青少年何时面临最大风险，并制定干预措施， 这些机制，并减少自杀行为在这些时期的风险。人际NLE可能导致 自杀行为通过其影响负面情绪状态（例如，激动）和社会联系， 并且进一步被拒绝敏感性、情绪调节困难和睡眠障碍放大。虽然 过去的研究发现这些结构与自杀行为有关，这项研究仅限于三个方面 主要方法：（1）大多数先前的研究都检查了长时间段（月和年），缺乏时间 决议要求在这些机制展开的时间尺度上（小时和天）审查这些机制。我们将 深入（超过数小时和数天）研究人际NLE与自杀行为的关系。(2)之甚少 了解社会系统的影响，如家庭单位，以及什么关键抵押品（例如，父母） 正在观察导致他们青少年自杀行为的短期因素。通过加入家长报告， 这项研究将揭示父母对青少年自杀风险的认识，并可能确定父母如何 可以帮助他们度过这些高风险时期。(3)过去的大多数工作都没有足够的力量来检验 与自杀行为有关（而不是关注自杀想法）。我们建议研究如何以及为什么 人际NLE使用基于智能手机的生态瞬间赋予自杀行为风险 评估（EMA）和可穿戴传感器（即，腕动计）的600名青少年和他们的父母 急性心肌梗死患者出院后一个月内从三个不同的研究中心（布朗、旧自治领、罗格斯）招募 精神病治疗我们将实现三个目标：目标1。检查人际关系（特别是家庭和同伴） NLE通过增加消极情绪和减少社交活动来增加自杀行为的风险 连通性目标2.研究拒绝敏感性如何调节人际NLE与 消极情绪/社会联系减少。目标3。检查睡眠障碍和情绪 调节困难缓和了负面情绪增加和社会联系减少与 自杀行为这项工作将大大促进对自杀行为近端风险的理解， 青少年以及该领域如何评估和对待自杀青少年。

PROJECT SUMMARY Suicide is the 2nd leading cause of death among adolescents, and, alarmingly, rates have continued to increase over the past decade. With the current dearth of empirically supported psychosocial interventions for adolescent suicidal behavior, there is a great need to identify processes underlying risk for this outcome. Interpersonal negative life events (NLEs) have been linked to short-term risk for suicidal behavior (i.e., suicide attempts and deaths). However, how or why these interpersonal NLEs confer risk is currently unclear. Understanding the moderators and mechanisms of the link between interpersonal NLEs and suicidal behavior is crucial in order to identify when adolescents are most at risk and to develop interventions that can target these mechanisms and reduce suicidal behavior during these periods of risk. Interpersonal NLEs may lead to suicidal behavior through their impact negative emotional states (e.g., agitation) and social connectedness, and further magnified by rejection sensitivity, emotion regulation difficulties, and sleep disturbance. Although past studies have found these constructs to be linked with suicidal behavior, this research is limited in three key ways: (1) Most prior studies have examined long time periods (months and years), which lack the temporal resolution to examine these mechanisms on the time scale in which they unfold (hours and days). We will intensively (over hours and days) examine how interpersonal NLEs relate to suicidal behavior. (2) Little is known about the impact of the social system, such as the family unit, and what key collaterals (e.g., parents) are observing in the short-term leading up to their adolescent’s suicidal behavior. By including parental reports, this study will reveal parents’ awareness of their adolescents’ suicide risk and potentially identify how parents can help them during these high-risk times. (3) Most past work has been insufficiently powered to examine links with suicidal behavior (instead focusing on suicidal thoughts). We propose to examine how and why interpersonal NLEs confer risk for suicidal behavior using smartphone-based ecological momentary assessment (EMA) and wearable sensors (i.e., wrist actigraphy) among 600 adolescents and their parents recruited from three diverse sites (Brown, Old Dominion, Rutgers) during the month after discharge from acute psychiatric care. We will address three aims: Aim 1. Examine how interpersonal (particularly familial and peer) NLEs increase risk for suicidal behavior through increased negative emotion and decreased social connectedness. Aim 2. Examine how rejection sensitivity moderates the link from interpersonal NLEs to negative emotionality/decreased social connectedness. Aim 3. Examine how sleep disturbance and emotion regulation difficulties moderate links from increased negative emotions and decreased social connectedness to suicidal behavior. This work will significantly advance understanding of proximal risk for suicidal behavior in youth and how the field assesses and treats suicidal adolescents.