Risk and resilience to late-life suicidal ideation and behavior after spousal bereavement: Targeting social connectedness to strengthen circadian rhythmicity

项目摘要/摘要 我们过去的研究表明，社会脱节和冲突关系的感觉 常常削弱自杀威慑力的因素。经历配偶或生活伴侣的死亡是一种 可能导致日常生活发生突然变化的令人深感痛苦的事件，包括自我意识下降 照顾和退出社会活动。虽然大多数人会随着时间的推移而适应，但相当多的人 年长的丧偶(20%-35%)经历抑郁、孤独、自杀念头和过早死亡， 包括自杀死亡。因此，晚年丧偶提供了一个“自然实验”，在这个实验中 研究明确且常见的社会压力源对晚年自杀风险的影响。这样做的目的是 R01的应用是为了检查在配偶早期的晚年自杀的风险和弹性。 通过调查(1)社会联系对自杀风险和 (2)昼夜节律不稳定(睡眠、活动、进餐和社交的不一致模式)是否有帮助 解释这种联系。我们将招收169名65岁及以上的丧偶成年人，他们目前 至少有阈值以下的抑郁症状或有抑郁史和/或自杀未遂。我们 将包括配偶死亡后早期的参与者：在失去配偶后的前六个月内。所有参与者将 在12个月内完成对社会联系的多个维度的重复评估，临床 评估(抑郁和自杀意念)，以及对昼夜节律性的客观评估 (活动图衍生的24小时休息/活动模式、睡眠开始和计时，以及昼夜节律阶段推进或 延迟)。因此，我们将能够调查昼夜节律性和延迟的睡眠开始和时间 会与更高的自杀风险相关。参与者还将完成一项行为调查，旨在 促进丧失亲人的老年配偶的自我照顾行为(称为“好”或丧偶长辈的生活方式 Lost)，一种数字健康干预。Well以社交活动、睡眠和用餐的时间和规律为目标 确定改变社交联系是否降低自杀风险，以及昼夜节律是否 稳定性在一定程度上解释了这种联系。初步数据表明，油井增加了(A)稳定性 昼夜节律(即规律的睡眠、活动、用餐和社交)和(B)社会联系。我们会 充分利用我们的纵向设计和使用高维统计的重复评估 考察社会连通性多个维度的纵向变化与变化之间关系的模型 在昼夜节律稳定中，作为一种可能的生物行为机制，无论是直接和/或间接 会影响晚年的自杀风险。拟议的研究通过确定(1)与RFA MH-22-135相一致 “社会脱节带来自杀风险的机制，以及社会融合防止自杀的机制 晚年的思想和行为；“和(2)”可以成为目标的生物和行为机制 一种干预性发展的实验性治疗方法。

PROJECT SUMMARY / ABSTRACT Our past research has demonstrated that feelings of social disconnectedness and conflictual relationships are factors that often undermine deterrents to suicide. Experiencing the death of a spouse or life partner is a profoundly distressing event that may cause abrupt changes in one’s daily routine, including decreased self- care and withdrawal from social activities. While most individuals adapt over time, a substantial number of older bereaved spouses (20-35%) experience depression, loneliness, suicidal thoughts, and early mortality, including death by suicide. Thus, late-life spousal bereavement provides a “natural experiment” in which to study the impact of a well-defined and common social stressor on suicide risk in late life. The objective of this R01 application is to examine the risk for and resilience to late-life suicide during the early spousal bereavement period by investigating the extent to which (1) social connectedness influences suicide risk and (2) whether circadian rhythm instability (inconsistent patterns of sleep, activity, meals, and socialization) helps explain this association. We will enroll 169 spousally-bereaved adults aged 65 years or older, who currently have at least subthreshold symptoms of depression or have a history of depression and/or suicide attempt. We will include participants early after spousal death: during the first six months post loss. All participants will complete repeated assessments over 12 months of multiple dimensions of social connectedness, clinical assessments (depression and suicide ideation), and objective assessments of circadian rhythmicity (actigraphy-derived 24-hour patterns of rest/activity, sleep onset and timing, and circadian phase advances or delays). Thus, we will be able to investigate whether circadian rhythmicity and delayed sleep onset and timing will be associated with higher suicide risk. Participants will also complete a behavioral probe, designed to promote self-care behaviors in older bereaved spouses (called “WELL” or Widowed Elders’ Lifestyle After Loss), a digital health intervention. WELL targets the timing and regularity of social activities, sleep, and meals to determine whether modifying social connectedness reduces suicide risk and whether circadian rhythm stability explains part of this association. Preliminary data indicate that WELL increases both (a) stability of circadian rhythms (i.e., regular sleep, activity, meals, and socialization) and (b) social connectedness. We will take full advantage of our longitudinal design and repeated assessments by using high-dimensional statistical models to examine how longitudinal change in multiple dimensions of social connectedness relates to change in circadian rhythm stability as a possible biobehavioral mechanism, and whether it directly and/or indirectly effects suicide risk in late-life. The proposed research aligns with RFA MH-22-135 by identifying (1) “mechanisms by which social disconnection confers risk for, and social integration protects against suicidal thoughts and behaviors in late life;” and (2) ”biological and behavioral mechanisms that can be targets within an experimental therapeutic approach of intervention development.”