Short Term Variability in Affect and Rest Activity Rhythms in Long Term Chronic and Highly Variable Suicidal Ideation in Depressed Older Adults

摘要 我们正在进行的研究（R 01 MH 085651）旨在确定老年抑郁症患者的长期自杀风险因素。在这 作为补充，我们建议研究一个新的研究方向，重点是如何接近危险因素，如严重程度和 情绪波动、24小时休息-活动节律的日间稳定性和睡眠健康与自杀风险相关， 抑郁的老年人睡眠健康状况不佳和24小时休息-活动节律（RAR）中断与以下因素有关： 老年人发病率和死亡率的众多指标，包括自杀意念。情感失调也是 与自杀意念和年轻人的自杀行为有关虽然存在复杂的双向 自杀风险，睡眠/活动和情绪之间的关系，这些关系尚未使用 在明确定义的自杀风险组中进行体动记录和数字监测。我们建议为3- 一项为期一周的试点研究，测量日常情绪和休息活动节律（通过数字监测和活动记录仪）， 实时评估潜在的自杀风险因素，迄今为止尚未在母研究中进行评估。参与者的临床数据 和认知表征，包括自杀意念轨迹，将由母研究提供。参与者 年龄在60岁及以上，参加父母补助，并符合单相重度抑郁症的标准 插曲。我们的数据表明，慢性严重和高度可变的想法者有更高的风险， 自杀行为比低/非自杀者，组将包括两个高自杀风险组（慢性严重自杀者：N=20， 高度可变的意念者：N=20）和一个低自杀风险组（无/最小意念：N=20）。影响收视率和数字 将在连续3周内每天收集两次睡眠日记，并将RAR指标（使用客观活动计数 模式）将在同一时期收集，以日间稳定性作为主要RAR指标。拟议 研究与唤醒/调节系统的RDoC类别一致，包括昼夜节律和 睡眠/觉醒。我们建立在我们的研究团队的互补专业知识：Szanto博士（晚年自杀， 自杀高危人群的预防和干预研究），Franzen博士（昼夜节律和睡眠及其 与青少年和年轻人自杀风险的关系），斯塔尔博士（数字监测，老年抑郁症， 干预发展，以改善昼夜节律和睡眠），Galfalvy博士（分析自杀数据，包括 数字监测和时间序列数据）和古杰拉尔博士（老年抑郁症和体力活动）。拟议工作 通过识别可改变的近端行为风险来补充我们目前对长期自杀风险因素的研究 可以用来改善自杀预防的因素。

ABSTRACT Our ongoing research (R01 MH085651) aims to identify long-term suicide risk factors in older depressed adults. In this supplement, we propose to study a new line of research focusing on how proximal risk factors, such as severity and fluctuation of affect, inter-daily stability of the 24-hour rest-activity rhythm, and sleep health relate to suicide risk in depressed older adults. Poor sleep health and disruption of the 24-hour rest-activity rhythm (RAR) are linked to numerous indices of morbidity and mortality in older adults, including suicidal ideation. Affect dysregulation is also linked to contemplation of suicide and suicidal behavior in younger age groups. While there are complex, bi-directional relationships between suicide risk, sleep/activity, and mood, these relationships have yet to be measured using actigraphy and digital monitoring in well-defined suicide risk groups. We propose an Administrative Supplement for a 3- week pilot study measuring daily affect and rest-activity rhythms (via digital monitoring and actigraphy) to provide a real-time assessment of potential suicide risk factors so far unevaluated in the parent study. Data on participants’ clinical and cognitive characterization, including suicidal ideation trajectories, will be provided by the parent study. Participants will be aged 60 years and older, enrolled in the parent grant, and have met criteria for unipolar major depressive episode. Building on our data that indicated that both chronic severe and highly variable ideators had a higher risk of suicidal behavior than low/non-ideators, groups will include two high suicide risk groups (chronic severe ideators: N=20, highly variable ideators: N=20) and one low suicide risk group (no/minimal ideation: N=20). Affect ratings and digital sleep diaries will be collected twice daily over 3 consecutive weeks, and RAR metrics (using objective activity count patterns) will be collected during the same period, with interdaily stability as the primary RAR measure. The proposed research aligns with RDoC category of Arousal/Regulatory Systems including constructs such as Circadian Rhythms and Sleep/Wakefulness. We build on the complementary expertise of our research team: Dr. Szanto (late-life suicide, prevention and intervention studies with high suicide risk groups), Dr. Franzen (circadian rhythms and sleep and their relationship to suicide risk in adolescents and young adults), Dr. Stahl (digital monitoring, geriatric depression, intervention development to improve circadian rhythmicity and sleep), Dr. Galfalvy (analyses of suicide data, including digital monitoring and time series data), and Dr. Gujral (geriatric depression and physical activity). The proposed work complements our current work on long-term suicide risk factors by identifying modifiable proximal behavioral risk factors that can be used to improve suicide prevention.