Suicidal Thoughts and Behaviors in Young Children: Cognitive, Behavioral and Affective Risk Factors

项目摘要 尽管自杀被认为是12岁以下儿童死亡的主要原因，但很少有 关于青春期前儿童自杀的研究，只有少数几项研究集中在学龄前儿童。然而， 从发展的角度来看，幼儿时期可能是研究突发自杀的关键时期。 思想和行为，在情绪调节方面有显著的增长和变化，以及发展 认知能力，包括对死亡的新兴理解。这项申请的调查人员 以前对3-7岁儿童的临床样本(n=390)中的自杀想法、计划和企图进行了检查 参加我们精神科部分住院计划的儿童。半结构化的诊断性访谈 (与主要照顾者进行的)显示，自杀的想法和行为与老年人有关 儿童年龄和并发抑郁症、对立违抗障碍(ODD)的比率较高，以及 单变量分析中的创伤后应激障碍(PTSD)，年龄和抑郁仍然是显著的 多元Logistic回归模型中的预测因素。作为对高风险性质的进一步支持 有自杀倾向的学龄前儿童，我们也发现自杀念头/行为是最强烈的倾向 多变量分析中再入院时间的预测因子。本申请旨在加深我们对 非常早期的自杀想法和行为，使用RDoC方法选择我们 假设在这个年龄段与自杀行为的风险最密切相关。具体地说，这 应用程序寻求更好地描述潜在的RDoC正价和负价系统以及 学龄前儿童与自杀相关的认知系统，因为它们可能是自杀行为的先兆 无论是在学龄期还是青春期。为了解决这些问题，我们将招聘一名同等的 4至7岁，有(n=45)和没有(n=45)父母报告有自杀意念或 来自儿科部分住院项目的行为。此外，我们还将研究父母的角色 自杀行为史对子女自杀行为的影响为了解生物风险奠定基础 在未来更大的审判中这么年轻的时候自杀。与幼儿有关的探索性问题 对死亡的理解也将被考察。这项研究的长期目标是确定 在这个非常年轻的样本中，与自杀有关的风险因素有助于阐明自杀意念的轨迹。 以及从学龄前到学龄儿童到青少年的行为，以及识别特定的脆弱性 可能影响预防性干预的因素。这项研究针对NIMH战略目标2.2， 确定临床上有用的生物标记物和行为指标，以预测在整个生命周期的变化。 疾病“。它还涉及NIMH/全国预防自杀行动联盟的优先研究议程 对于自杀预防的关键问题，为什么人们会自杀，特别是推荐的简短- 术语目标：确定与自杀风险相关的认知功能障碍。

Project Summary Despite the fact that suicide is recognized as a leading cause of death in children under 12, there are few studies of suicide in prepubescent children and only a handful of studies focusing on preschoolers. However from a developmental perspective, early childhood may be a critical period in which to study emergent suicidal thinking and behavior, given significant growth and changes in emotion regulation, as well as developing cognitive capacities that include an emerging understanding of death. The investigators on this application previously examined suicidal thoughts, plans, and attempts in a clinical sample (n = 390) of 3- to 7-year-old children presenting to our psychiatric partial hospitalization program. A semi-structured diagnostic interview (conducted with a primary caregiver) revealed that suicidal thinking and behavior was associated with older child age and with higher rates of concurrent depression, oppositional defiant disorder (ODD), and posttraumatic stress disorder (PTSD) in univariate analyses, with age and depression remaining as significant predictors in a multivariate logistic regression model. As further support for the high-risk nature of preschoolers with suicidality, we also found that suicidal thoughts/behaviors was the strongest prospective predictor of time to readmission in multivariate analysis. This application seeks to further our understanding of very early suicidal thoughts and behaviors, using an RDoC approach for the selection of constructs that we hypothesize to be most closely related to risk for suicidal behavior in this age group. Specifically, this application seeks to better characterize underlying RDoC Positive and Negative Valence Systems as well as Cognitive Systems relevant to suicidality in preschoolers, as they may be a precursor to suicidal behavior during both school age years and adolescence. In order to address these questions, we will recruit an equal number of youth, 4 to 7 years old, with (n = 45) and without (n = 45) parent-reported suicidal ideation or behavior from a pediatric partial hospitalization program. In addition, we will examine the role of parental history of suicidal behavior on their children’s suicidality to lay the groundwork for understanding biologic risk for suicidality at this young age in a future larger trial. Exploratory questions related to young children’s understanding of death will also be examined. The long-term goals of this research are to determine whether risk factors associated with suicidality in this very young sample help explicate the trajectory of suicidal ideation and behavior from preschool to school aged children to adolescents as well as to identify specific vulnerability factors that may inform preventative interventions. This research addresses NIMH Strategic Objective 2.2, to, “identify clinically useful biomarkers and behavioral indicators that predict change across the trajectory of illness”. It also addresses NIMH/National Action Alliance for Suicide Prevention’s Prioritized Research Agenda for Suicide Prevention key question of why do people become suicidal, particularly the recommended short- term objective of identifying cognitive dysfunction associated with suicide risk.