Non-Suicidal Self-Injury in Children: Brain/behavior Alterations and Risk for Suicidal Behavior

儿童非自杀性自伤：大脑/行为改变和自杀行为风险

• 批准号: 9307229
• 负责人: DANIEL P DICKSTEIN
• 金额: $ 61.39万
• 依托单位: EMMA PENDLETON BRADLEY HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-03-22 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9307229
• 关键词: Accident and Emergency department; Accounting; Address; Adolescent; Adolescent Risk Behavior; Affect; Aftercare; Aggressive behavior; American; Amygdaloid structure; Base of the Brain; Behavior; Behavioral; Behavioral Mechanisms; Biological; Brain; Cause of Death; Centers for Disease Control and Prevention (U.S.); Child; Childhood Injury; Classification; Cognitive remediation; Comorbidity; Coupled; Data; Depression and Suicide; Development; Ecological momentary assessment; Emergency department visit; Event; Feeling suicidal; Foundations; Functional Magnetic Resonance Imaging; Functional disorder; Future; Gender; Goals; Healthcare; High School Student; Hospitalization; Impulsivity; Knowledge; Lead; Measures; Mental Health; Methods; Modeling; National Institute of Mental Health; Participant; Pharmaceutical Preparations; Prefrontal Cortex; Prevention; Psychological reinforcement; Psychopathology; Reporting; Research; Research Methodology; Rest; Risk; Risk Behaviors; Risk Factors; Role; Sampling; Scanning; Self-Injurious Behavior; Social Functioning; Solid; Specificity; Suicide; Suicide attempt; Suicide prevention; Surveys; Symptoms; Teenagers; Testing; Training; Translating; Youth; accomplished suicide; base; behavior change; biobehavior; brain behavior; follow-up; improved; innovation; medical attention; meetings; multidisciplinary; non-suicidal self injury; novel; peer; personalized intervention; personalized medicine; response; social; suicidal; suicidal behavior; suicidal risk; suicide attempter; suicide rate

PROJECT SUMMARY/ABSTRACT: BACKGROUND: Non-suicidal self-injury (NSSI)—defined as deliberate destruction of one's body in the absence of intent to die (most commonly self-cutting)—accounts for 25% of 7-24 year olds seen in emergency departments annually for self-harm and increases the risk for a suicide attempt (SA) by as much as 7-fold. Moreover, suicide is the second leading cause of death of 10-24 year olds in the U.S. Thus, there is a critical need to identify the brain/behavior mechanisms underlying NSSI itself and also the circuit/behavior/symptoms predictors of which youths engaged in NSSI-only will make a first-onset SA (and which will not). THE PRIMARY OBJECTIVES are (1) to identify functional magnetic resonance imaging (fMRI) differences between youths engaged in NSSI vs. controls without psychopathology, (2) to determine the circuit, behavior, and symptom factors associated with first-onset SA, and (3) to test moderators of this relationship including irritability, social function, and impulsive aggression. OUR CENTRAL HYPOTHESIS, based on preliminary data from our American Foundation for Suicide Prevention study of teens engaged in NSSI-only is that (a) youths engaged in NSSI-only without a prior SA have behavior/circuit alterations in a prefrontal cortex (PFC)- amygdala circuit during tasks tapping implicit associations with suicide and response to peer acceptance vs. rejection, and (b) these circuit alterations, moderated by irritability, impulsive aggression, and social dysfunction, put youths at greater risk for future suicidal behavior. RESEARCH METHOD: We will test this hypothesis by comparing 150 youths engaged in NSSI-only (without prior SA) vs. 50 typically-developing control (TDC) youths on circuit, behavior, and symptom measures, and then following the sample for 18 months to delineate what distinguishes those who progress to suicidal behavior. THE RATIONALE FOR THIS PROPOSAL is that greater knowledge of the brain/behavior mechanisms underlying NSSI and the relationship to subsequent first-onset SA will ultimately lead to a more brain-based classification and treatment approach for NSSI and suicide, which in turn would reduce risk, and enhance prevention for, suicidal behavior among children and adolescents. INNOVATION: Our study is innovative because it will uniquely synergize circuit and behavioral methods based on solid preliminary data with innovative ecological momentary assessments of NSSI/suicide and irritability, real-world assessment of social function, longitudinal follow up, and a committed multi-disciplinary team. SIGNIFICANCE: Our study is significant because it addresses gaps in knowledge about bio-behavioral mechanisms of both NSSI and also of a first-onset SA highlighted by the NIMH/National Action Alliance for Suicide Prevention's (NAASP) “Prioritized Research Agenda for Suicide Prevention” and the June 2016 NIMH-sponsored meeting on “Mechanisms of Suicide Risk”—as these mechanisms provide the foundation for biological mechanism-based classification and treatments for NSSI and suicide.

项目摘要/摘要： 背景：非自杀的自我伤害（NSSI） - 被定义为故意破坏一个人的身体 缺乏死亡意图（最常见的是自我切割） - 在紧急情况下看到的7-24岁的25％的学会 每年进行自我伤害的部门，并增加自杀企图（SA）的风险多达7倍。 此外，自杀是美国10-24岁的第二大死亡原因，这是一个关键的 需要识别NSSI本身以及电路/行为/症状的大脑/行为机制 预测哪些年轻人仅从事NSSI-i-firly将成为第一届SA（也不会）。这 主要目标是（1）识别功能磁共振成像（fMRI）之间的差异 从事NSSI与没有心理病理学的对照的年轻人（2）确定电路，行为和 与第一心SA相关的症状因素，以及（3）测试这种关系的主持人，包括 烦躁，社会功能和冲动侵略性。我们的中心假设，基于初步 来自美国从事NSSi-lyly的青少年自杀预防研究基金会的数据是（a） 在没有先前的SA的情况下，从事NSSI的年轻人在前额叶皮层（PFC）中具有行为/电路改变 - 在任务期间，杏仁核电路利用自杀的隐式关联和对同伴接受的反应。 拒绝和（b）这些电路的改变，以易怒，冲动的侵略性和社会为主持 功能障碍，使年轻人面临未来自杀行为的更大风险。研究方法：我们将测试 假设通过比较150名仅从事NSSI的年轻人（没有先前的SA）与50个通常开发的年轻人 对照（TDC）在电路，行为和症状度量上的年轻人，然后跟随样本进行18 几个月来描述与自杀行为发展的人区分开的。理由 建议是对NSSI和关系的大脑/行为机制的更大知识 随后的第一款SA最终将导致更大的基于大脑的分类和治疗方法 对于NSSI和自杀，这反过来会降低风险，并提高预防自杀行为 儿童和青少年。创新：我们的研究具有创新性，因为它将唯一地协同回路和 基于固体初步数据的行为方法，具有创新的生态瞬时评估 NSSI/自杀和烦躁，社会功能的现实评估，纵向后续行动以及致力于 多学科团队。意义：我们的研究很重要，因为它解决了知识的差距 关于NSSI的生物行为机制以及NIMH/National突出显示的第一款SA 预防自杀的行动联盟（NAASP）“优先考虑预防自杀的研究议程”和 2016年6月NIMH赞助的有关“自杀风险机制”的会议 - 这些机制提供了 基于生物机制的基础NSSI和自杀的治疗方法。