Reward Valuation and Suicidal Behavior in High-Risk Adolescents

项目总结 自杀是全世界青少年死亡的主要原因，在过去十年中，自杀的比例有所上升。 然而，我们缺乏对自杀行为(SB)的可靠预测，部分原因是需要考虑更广泛的 评估的风险流程和方法。尤其迫切需要对……进行研究。 对SB进行客观的、前瞻性的预测，以确定处于最高风险的青年并阐明新的目标 干预。这项研究的目标是描述RDoC正价系统的变化， 尤其是神经过程涉及奖励评估，在一个大的，高风险的样本青少年急性 对自伤思想和行为(SITB)的精神治疗，将跟踪6个月 出院后--某人的高风险时期。我们关于某人的初步数据和理论突出了一个关键作用 在某种程度上反映了一个人的选择，那就是要立即摆脱精神上的痛苦而不是 等待来自继续生活在困难时期的潜在的未来回报。与一致 这一严谨的横截面研究将某人与延迟货币价值的更大贴现联系在一起 奖励，我们的初步数据表明，相对于延迟，神经对立即的反应增强 年轻时因新近的某人而获得的奖励。重要的是，更喜欢立即而不是延迟的增强剂 已知在压力大的时候会增加，而严重的人际压力与某人的风险增加有关 在青少年中，而社会支持往往具有保护性。这项多方法的前瞻性研究将测试一个 SB的创新概念模型，通过该模型，具有增强神经反应性的年轻人对即刻增强剂的反应 对延迟奖励的迟钝反应更有可能对某人产生影响，特别是在紧急情况下 人际压力、社会支持对奖赏评价对SB的影响有缓冲作用。我们将招聘一名 青少年(13-17岁；N=300)在SITBS急性精神病治疗中的跨诊断样本。 参与者将完成临床评估以及奖励评估的行为和神经测量 医院捕获高危状态并将参与者的负担降至最低。出院后，参赛者将 在90天内完成一份关于人际压力、社会支持和SITB的简短每日调查。最后，参与者 将在出院后6个月完成对SITB的后续访谈，以测试SB的预期预测因素。这 研究将描述与高危青年SB病史相关的奖励估值模式(目标1)， 检验奖励评估的神经指标作为出院后SB的前瞻性预测因素 (目标2)，并考察了神经奖赏估值和近端人际因素之间的相互作用。 对SB的预测(目标3)。这项研究直接解决了NIMH的优先顺序，并将是第一个检查神经 在大量高危青年样本中预测未来SB的因素，扩大RDoC关于自杀风险的研究 到正价系统域。这项研究将导致确定客观的预测因素 为防止SB和自杀死亡，制定更个人化、有针对性的干预措施。

PROJECT SUMMARY Suicide is a leading cause of death for adolescents worldwide, and rates have increased over the past decade. Yet, we lack reliable predictors of suicidal behavior (SB) due in part to a need to consider a broader range of risk processes and methods of assessment. There is a particularly critical and urgent need for research on objective, prospective predictors of SB to identify youth at greatest risk and elucidate novel targets for intervention. The goal of this study is to characterize alterations in RDoC’s Positive Valence Systems, particularly neural processes involve in reward valuation, in a large, high-risk sample of adolescents in acute psychiatric treatment for self-injurious thoughts and behaviors (SITBs) who will be followed for 6 months following discharge—a period of high risk for SB. Our preliminary data and theories of SB highlight a key role of reward valuation in that SB partly reflects a choice between immediate relief from emotional pain rather than waiting for potential future rewards that come from continuing to live through difficult times. Consistent with this, rigorous cross-sectional research has linked SB to greater discounting of the value of delayed monetary rewards, and our preliminary data indicate enhanced neural responsiveness to immediate relative to delayed rewards in youth with recent SB. Importantly, preferences for immediate rather than delayed reinforcers are known to increase in times of high stress, and acute interpersonal stress is associated with elevated risk for SB in adolescents, while social support tends to be protective. This multi-method, prospective study will test an innovative conceptual model of SB by which youth with enhanced neural reactivity to immediate reinforcers and blunted reactivity to delayed rewards are more likely to engage in SB, particularly in times of acute interpersonal stress, and social support buffers effects of reward valuation on SB. We will recruit a transdiagnostic sample of adolescents (ages 13-17 years; N=300) in acute psychiatric treatment for SITBs. Participants will complete clinical assessments and behavioral and neural measures of reward valuation in the hospital to capture a high-risk state and minimize participant burden. Following discharge, participants will complete a brief daily survey of interpersonal stress, social support, and SITBs for 90 days. Finally, participants will complete follow-up interviews of SITBs 6 months after discharge to test prospective predictors of SB. This study will characterize patterns of reward valuation associated with SB histories in high-risk youth (Aim 1), examine neural measures of reward valuation as prospective predictors of SB following hospital discharge (Aim 2), and examine the interplay between neural reward valuation and interpersonal factors in the proximal prediction of SB (Aim 3). This study directly addresses NIMH priorities and will be the first to examine neural predictors of future SB in a large, high-risk sample of youth, extending RDoC-informed research on suicide risk to the Positive Valence Systems domain. This research will lead to the identification of objective predictors of SB risk and the development of more personalized, targeted interventions to prevent SB and suicide deaths.