Developmental Pathways to Suicide Attempt

描述（由申请人提供）：本探索性研究将使用13波前瞻性纵向数据对两个正在进行的流行病学抽样队列2953名年轻人（300名有自杀企图）进行调查，该队列最初是在马里兰州巴尔的摩的28所内城公立学校进入一年级时招募的。该项目将评估个体精神、家庭（养育子女、家族史）、环境（遭受暴力、性虐待/身体虐待）、社会和高风险行为（性行为、吸毒）在发展过程中对不同自杀企图途径的影响。研究表明，预测自杀死亡和自杀企图是非常困难的，可能是因为有多种途径或亚型。亚型的识别非常重要，因为针对亚型的适当干预方法可能不同。也有可能SA亚型可以代表更同质的遗传群体，从而更有能力检测SA易感性的遗传变异。研究已经确定了风险和保护因素，但很少有研究通过发展过程确定多种因素，以确定过程或机制。在我们的社区样本中，大多数SA患者（约60%）从未达到DSM-IV的重度抑郁发作标准。越来越多的文献表明，攻击性/冲动性作为自杀风险的重要指标，可能具有生物学基础。目前尚不清楚是否存在一个由特质攻击定义的具有SA倾向增加的独特亚群。我们将研究参与者、同伴、父母、老师和公共记录（逮捕记录）所报告的童年、青少年和青年经历的多个领域。该项目将根据已确定的发育途径或轨迹，评估自杀企图风险的特定遗传标记（即SLC6A4， TPH1， BDNF, FKBP5）在整体和亚组中的影响。这项研究的结果将促进我们目前对不同种族的城市社区人口中自杀企图的过程和机制的理解。

DESCRIPTION (provided by applicant): This exploratory study will examine if there are unique pathways to suicide attempt using 13 waves of prospective longitudinal data on two ongoing epidemiologically sampled cohorts of 2953 young adults (300 with a prior suicide attempt) originally recruited upon entry to first grade in 28 inner city Public Schools in Baltimore, Maryland. This project will assess the influence of individual psychiatric, familial (parenting, family history), environmental (exposure to violence, sexual/physical abuse), social, and high risk behaviors (sexual, drug use) during the course of development on distinct pathways to suicide attempt. Research has shown that it is very difficult to predict suicide deaths and suicide attempt, perhaps because there are multiple pathways or subtypes. The identification of subtypes is highly significant because appropriate intervention approaches for subtypes may differ. It is also possible that the SA subtypes could represent more homogenous genetic groups yielding greater ability to detect genetic variation in vulnerability for SA. Studies have identified risk and protective factors but few have identified multiple factors prospectively through the course of development to identify processes or mechanisms. The majority of participants with SA in our community sample (~60%) have never met DSM-IV criteria for a major depressive episode. There is a growing literature on the importance of trait aggression/impulsivity as a strong indicator of suicide risk with a possible biological basis. It is unclear if there is a distinct subgroup defined by trait aggression with increased liability of SA. We will study multiple domains of childhood, adolescent and young adult experiences as reported by the participants, peers, parents, teachers, and public records (arrest records). The project will assess the effect of specific genetic markers of risk for suicide attempt (i.e., SLC6A4, TPH1, BDNF, FKBP5) overall and in subgroups, based upon the developmental pathways or trajectories identified. The results of this study will advance our current understanding of the processes and mechanisms associated with suicide attempts among ethnically diverse, urban community populations. PUBLIC HEALTH RELEVANCE: This R21 project entitled "Developmental Pathways to Suicide Attempt" aims to identify distinct pathways or trajectories to suicide attempt in 2953 young adults (300 suicide attempters) initially recruited upon entry to first grade in Baltimore City Public Schools. Improvement in the ability to predict suicide attempts through the identification of specific risk and protective factors experienced over the course of child and adolescent development is an important goal for the prevention of suicide.