Temporal dynamics of stress, sleep, and arousal in short-term risk for adolescentsuicidal behavior

虽然其他主要死因大幅下降，但年轻人的自杀率却有所上升。它是 青少年死亡的第二大原因，以及该年龄段的医院自杀事件 在过去的十年里翻了一番。在50年的研究中，该领域几乎完全专注于长期的 自杀结局的长期风险，平均随访期为10年。事实上，只有一次 成人自杀行为和青少年自杀行为短期风险的研究。这一点值得注意，因为长时间- 长期风险因素往往不能很好地预测短期风险。因此，目前的证据基础是 医疗服务提供者在确定近期风险和相应的适当临床风险方面的决定 反响相当有限。青少年自杀行为的基本比率很低，这对 研究这种结果的短期风险，这在很大程度上解释了在这方面缺乏研究的原因 区域。为了克服这一困难，从高危人群中提取大量样本是必要的。在当前 在这项提议中，我们处于解决这一困难的独特地位。也就是说，我们将利用来自 我们目前对青少年精神科住院患者自杀风险的研究之一是将这些数据与数据合并 对200名新患者进行了收集，最终抽取了400名患者。此外，非卧床的最新发展 评估技术为阐明近端自杀的时间动力学提供了新的机会 风险，从而解决了一个难以捉摸的问题，即一个人是否有自杀的风险 在不久的将来，但当他们可能面临最大风险的时候，他们的行为。当前应用程序将评估Aousal(在 压力和睡眠障碍的形式)与使用非卧床自杀结局的近期风险有关 评估措施。具体地说，采用生态瞬时评估、移动生物传感器和 我们的目标是评估时变压力之间的相互关系(在心理、社会和生理层面)。 和睡眠不规律在自杀意念和事件(自杀企图和事件)风险的时间动态中 急性自杀的重症临床护理)出院后一个月以上。考虑到前额叶皮质的 参与调节唤醒，我们还将评估执行功能是否在基线水平上有所缓和 时变压力和睡眠不规律对这些自杀结果的近期风险的影响。最后，我们 将用计算精神病学的新进展来补充传统的统计方法。这项建议 是创新的，通过独特的统计能力来阐明近期风险的时间动态 自杀事件，并利用新技术将多种方法(即，行为、生理、 神经认知和自我报告测量)，包括三个连续的动态评估数据流， 跨多个分析单元(即，心理社会和生理压力)。此应用程序可以标识 在高危时期监测患者的重要变量，并确定具体和易处理的 治疗目标，从而为未来的临床干预努力提供方向。

While other leading causes of death have seen significant declines, suicide rates in youth have increased. It is the second leading cause of death among adolescents, and hospital encounters for suicide in this age group have doubled over the last decade. In 50 years of research, the field has focused almost exclusively on long- term risk for suicidal outcomes, with an average follow-up period of 10 years. Indeed, there has been only one study of short-term risk for suicidal behavior in adults and none in adolescents. This is notable because long- term risk factors tend to be poor predictors of short-term risk. Consequently, the current evidence base for healthcare providers' decisions in determining proximal risk and the corresponding appropriate clinical response is quite limited. The low base rate of suicidal behavior in adolescents is particularly challenging for studying short-term risk for this outcome, and this in large part accounts for the absence of research in this area. To overcome this difficulty, large samples drawn from high-risk populations are necessary. In the current proposal, we are uniquely positioned to address this difficulty. That is, we will leverage secondary data from one of our current studies of suicide risk in adolescent psychiatric inpatients by pooling these data with data collected on 200 new patients for a final sample of 400. Additionally, recent developments in ambulatory assessment technologies offer novel opportunities for elucidating the temporal dynamics of proximal suicidal risk, thereby addressing the elusive question of not only whether an individual is at risk for engaging in suicidal behavior in the near future but when they may be most at risk. The current application will evaluate arousal (in the form of stress and sleep disturbance) in relation to proximal risk for suicidal outcomes using ambulatory assessment measures. Specifically, employing ecological momentary assessment, a mobile biosensor, and actigraphy, we aim to evaluate the interrelation of time-varying stress (at psychosocial and physiological levels) and sleep irregularity in the temporal dynamics of risk for suicidal ideation and events (suicide attempts and intensive clinical care for acute suicidality) over one month post-discharge. Given the prefrontal cortex's involvement in regulating arousal, we will also evaluate whether executive functioning at baseline moderates the effects of time-varying stress and sleep irregularity on proximal risk for these suicidal outcomes. Finally, we will supplement traditional statistical methods with novel advances in computational psychiatry. This proposal is innovative by being uniquely powered statistically to clarify the temporal dynamics of proximal risk for suicidal events, and leveraging new technologies to combine multiple methods (i.e., behavioral, physiological, neurocognitive, and self-report measures), including three continuous streams of ambulatory assessment data, across multiple units of analysis (i.e., psychosocial and physiological stress). This application may identify important variables for monitoring of patients during periods of elevated risk and identify specific and tractable treatment targets, thus providing directions for future clinical intervention efforts.