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

项目总结 自杀是青少年死亡的第二大原因，令人担忧的是，自杀的比率继续上升 在过去十年中有所增加。由于目前缺乏经验支持的心理社会干预措施 对于青少年自杀行为，非常需要确定导致这一结果的潜在风险的过程。 人际负性生活事件(NLE)与自杀行为(即自杀)的短期风险有关 企图和死亡)。然而，目前还不清楚这些人际关系中的NLE是如何或为什么带来风险的。 了解人际关系不良事件与自杀行为之间联系的调节因素和机制 对于确定青少年何时处于最危险状态并制定干预措施具有重要意义 这些机制和减少自杀行为在这些风险时期。人际关系中的NLEs可能导致 自杀行为通过其负面情绪状态(例如，激动)和社会联系产生的影响， 并因拒绝敏感、情绪调节困难和睡眠障碍而进一步放大。虽然 过去的研究已经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)以前的研究大多考察了较长的时间周期(月和年)，缺乏时间上的 在这些机制展开的时间尺度(小时和天)上审查这些机制的决议。我们会 深入研究(持续数小时和数天)人际关系中的不良生活事件与自杀行为的关系。(2)小事 了解社会制度的影响，如家庭单位，以及主要的附属机构(如父母) 在短期内观察他们青少年的自杀行为。通过包括父母报告， 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 可以在这些高风险时期帮助他们。(3)过去的大部分工作都没有足够的力量来审查 与自杀行为有关(而不是关注自杀念头)。我们建议研究如何以及为什么 人际关系中的NLEs会增加使用智能手机的生态瞬间自杀行为的风险 对600名青少年及其父母的评估(EMA)和可穿戴传感器(即手腕动作记录仪) 从三个不同的地点(布朗，老多米尼恩，罗格斯)在急性出院后一个月内招募 精神科护理。我们将解决三个目标：目标1.检查人际关系(特别是家庭和同伴) NLEs通过增加负面情绪和减少社交而增加自杀行为的风险 连通性。目标2.研究拒绝敏感度如何缓和人际关系中的不良生活事件 消极的情绪性/减少的社会联系。目标3.检查睡眠障碍和情绪 监管困难缓解了负面情绪增加和社会连接性下降的联系 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。 青少年以及外地如何评估和对待有自杀倾向的青少年。

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.