Implicit and Explicit Suicidal Cognition and Risk for Opioid Overdose

项目总结/摘要 我们建议调查成人阿片类药物过量与自杀认知之间的关系。 使用障碍。2016年，美国有超过4.2万人死于阿片类药物过量， 自20世纪90年代末以来，死亡人数不断上升。此外，高达70%的阿片类药物使用障碍患者报告说， 非致命性药物过量史，与昂贵的医疗保健服务利用和未来风险相关 过量致死过量通常被分类为故意的（即，自杀）或意外。数据 这表明意外过量和自杀是相关，并经常共同发生在那些与阿片类药物使用 disorder.据估计，20-30%的阿片类药物使用障碍患者报告有自杀企图和 服药过量此外，自杀企图和过量服用往往是在压力事件之前，这表明 压力可能是吸毒过量和自杀的共同诱因。然而， 自杀念头和阿片类药物过量之间的联系可能被大大低估了。二分分类 过量用药的方案极易受到错误分类的影响，因为（1）自杀想法发生在沿着 连续体，和（2）自杀评估受到众所周知的报告偏见（例如，不愿 参与者因害怕住院而报告自杀想法）。因此，许多药物过量被归类为 事实上，意外事故发生之前可能会有死亡的想法，这一发现得到了我们初步数据的支持。 此外，使用自杀认知的内隐测量提供了显着的额外好处， 仅使用自我报告措施，并可能发现使用其他方法遗漏的自杀想法。 因此，迫切需要量化自杀想法与阿片类药物过量之间的关联 提高对自杀对过量危机的影响的理解，并确定潜在的目标， 干预因此，我们的目的是探讨自杀认知与阿片类药物之间的关系 过量，并量化对压力的反应性增强与过量和 自杀企图拟议的研究包括两个目标，为此，我们建议招募男性和女性 阿片类药物使用障碍，有或没有阿片类药物过量史。第一个目标是量化 内隐和外显自杀认知与阿片类药物过量之间的关联。第二个目标是量化 对压力的情感和外周生理反应增强与 吸毒过量和自杀未遂这项研究的结果将提供有关重叠的重要信息 自杀念头和阿片类药物过量之间的关系，以及对压力的反应和这两者之间的关系。 潜在的致命行为。这项研究的结果将极大地促进对以下联系的认识： 自杀和阿片类药物过量，并最终告知新的治疗方法的发展，以降低风险， 服药过量

Project Summary/Abstract We propose to investigate the association between suicidal cognition and opioid overdose in adults with opioid use disorder. In 2016, over 42,000 people died from opioid overdose in the United States, continuing the escalation of deaths since the late 1990s. Moreover, up to 70% of those with opioid use disorder report a history of nonfatal overdose, which is associated with costly health care service utilization and risk for future fatal overdose. Overdoses are generally categorized as either intentional (i.e., suicidal) or accidental. Data suggest that accidental overdose and suicide are related and often co-occur among those with opioid use disorder. An estimated 20-30% of those with opioid use disorder report a history of both suicide attempt and overdose. Furthermore, suicide attempts and overdoses are often preceded by a stressful event, suggesting that stress may be a common precipitating factor for both overdose and suicide. However, the relationship between suicidal thoughts and opioid overdose may be greatly underestimated. Dichotomous classification schemes for overdose are highly vulnerable to misclassification because (1) suicidal thoughts occur along a continuum, and (2) suicide assessment is subject to well-known reporting biases (e.g., reluctance of participants to report suicidal thoughts due to fear of hospitalization). Thus, many overdoses classified as accidental may in fact be preceded by thoughts of death, a finding supported by our preliminary data. Moreover, the use of implicit measurement of suicidal cognition affords significant additive benefits beyond the use of self-report measures alone, and may detect suicidal thoughts that are missed using other methods. Accordingly, there is an urgent need to quantify the association between suicidal thoughts and opioid overdose to enhance understanding of the impact of suicide on the overdose crisis and to identify potential targets for intervention. Therefore, our objective is to investigate the association between suicidal cognition and opioid overdose and to quantify the association between heightened reactivity to stress and both overdose and suicide attempts. The proposed study consists of two aims for which we propose to recruit men and women with opioid use disorder with and without a history of opioid overdose. The first aim is to quantify the association between implicit and explicit suicidal cognition and opioid overdose. The second aim is to quantify the association between heightened affective and peripheral physiological reactivity to stress and history of overdose and suicide attempts. The results from this study will provide important information about the overlap between suicidal thoughts and opioid overdose, and the relationship between reactivity to stress and these two potentially fatal behaviors. The results of this study will critically advance knowledge on the link between suicide and opioid overdose and ultimately inform the development of novel treatments to reduce the risk for overdose.