Impulsive Aggression, Neurocognition, and Suicidal Behavior in Depressed Youth

描述（由申请人提供）：重度抑郁症（MDD）是青少年自杀行为最重要的精神危险因素，但大多数抑郁的青少年从未尝试过自杀，这削弱了MDD诊断在衡量未来自杀行为风险方面的积极预测价值。预防青少年自杀的努力将从对抑郁青少年自杀行为的前兆和途径的深入了解中受益匪浅，特别是如果这些知识能够为有效的风险评估和干预策略的发展提供信息。了解增加抑郁青少年未来自杀企图风险的可测量因素对预防青少年自杀的努力至关重要，因为：1)帮助认识到自杀风险特别高的抑郁青少年，他们至少需要更密切的监督和控制；2)确定除情绪障碍本身外的临床干预目标；3)促进评估工具和风险标记的发展，以更好地衡量个人自杀风险，并为自杀风险青少年的临床干预研究提供信息。早期研究者（ESI）提出的R01申请将通过检查冲动攻击和神经认知功能在MDD青少年自杀行为发病机制中的作用来解决知识上的关键空白。核心假设是，冲动攻击和执行功能和决策的缺陷将对未来自杀企图的模型做出重大贡献，并为传统的评估方法增加积极的预测价值。我们的假设是由有希望的试点工作提供的，在试点工作中，冲动性攻击和决策缺陷的测量明显区分了抑郁的青少年自杀未遂者和非自杀未遂者。设计包括横断面比较和前瞻性纵向研究，研究对象为300名有或没有自杀企图史的抑郁青少年，从青春期早期到青春期中期是自杀行为风险最高的发育时期。这些结果将有助于NIMH的使命，提高我们识别青少年重度抑郁症患者未来自杀行为前因的时间和可能的因果顺序的能力，从而为实际的临床风险评估、干预和自杀行为预防制定目标。

DESCRIPTION (provided by applicant): Major Depressive Disorder (MDD) is the most potent psychiatric risk factor for suicidal behavior in adolescents, yet most depressed youth never attempt suicide, diminishing the positive predictive value of a diagnosis of MDD in gauging the risk of future suicidal acts. Efforts to prevent youth suicide would benefit greatly from a deeper understanding of precursors and pathways to suicidal behavior in depressed youth, particularly if such knowledge informs the development of effective risk evaluation and intervention strategies. Knowledge of measurable factors that increase the risk of future suicide attempts in depressed adolescents could prove critical to efforts to prevent youth suicide by virtue of: 1) aiding in the recognition of depressed youth at especially heightened risk for suicide, who at a minimum may require closer supervision and containment; 2) identifying targets for clinical intervention beyond the mood disorder per se; and, 3) contributing to the development of assessment tools and risk markers relevant to better gauging individual suicide risk and informing clinical intervention research with youth at risk for suicide. The proposed R01 application from an early stage investigator (ESI) will address critical gaps in knowledge by examining the role of impulsive aggression and neurocognitive functioning in the etiopathogenesis of suicidal behavior in adolescents with MDD. The central hypothesis is that impulsive aggression and deficits in executive function and decision making will contribute substantially to a model of future suicide attempts and add positive predictive value to traditional assessment approaches. Our hypothesis is informed by promising pilot work in which measures of impulsive aggression and decision making deficits sharply distinguished depressed adolescent suicide attempters from non-attempters. The design includes cross-sectional comparisons as well as a prospective longitudinal study of 300 depressed youth with and without a prior history of suicide attempt, followed from early to middle adolescence, the developmental period of highest risk for suicidal behavior. These results will contribute to the mission of the NIMH by improving our capacity to identify the temporal and likely causal sequence of antecedents to future suicidal acts in youth with MDD, thus framing targets for practical clinical risk assessment, intervention, and the prevention of suicidal behavior.