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

基本信息

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
项目类别：
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

项目摘要

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：非自杀性自伤（NSSI）——定义为故意毁坏自己的身体缺乏死亡意图（最常见的是自残）——占 7-24 岁紧急情况患者的 25% 每年，部门都会对自残行为进行调查，并使自杀未遂 (SA) 的风险增加多达 7 倍。此外，自杀是美国 10-24 岁人群的第二大死因。因此，有一个关键的问题需要识别 NSSI 本身的大脑/行为机制以及电路/行为/症状哪些仅参与 NSSI 的青少年会首次出现 SA（哪些不会）的预测因素。主要目标是 (1) 识别功能性磁共振成像 (fMRI) 之间的差异参与 NSSI 的青少年与没有精神病理学的对照组相比，(2) 确定回路、行为和与首次发作 SA 相关的症状因素，以及 (3) 测试这种关系的调节因素，包括烦躁、社会功能和冲动攻击性，基于初步的假设。美国自杀预防基金会对仅参与 NSSI 的青少年进行的研究的数据是 (a) 仅参与 NSSI 而未事先进行 SA 的青少年的前额叶皮层 (PFC) 的行为/回路会发生变化 - 任务期间杏仁核回路挖掘与自杀的隐含关联以及对同伴接受与自杀的反应拒绝，以及（b）这些回路改变，由烦躁、冲动攻击和社交调节功能障碍，使青少年未来自杀行为的风险更大。研究方法：我们将对此进行测试。通过比较 150 名仅参加 NSSI（没有事先参加 SA）的年轻人与 50 名典型发展的年轻人来得出假设控制 (TDC) 青少年的电路、行为和症状测量，然后跟踪 18 名青少年几个月的时间来描述那些发展为自杀行为的人的特点。提议是更好地了解 NSSI 背后的大脑/行为机制及其关系随后的首次发作 SA 最终将导致更加基于大脑的分类和治疗方法 NSSI 和自杀，这反过来又会降低自杀行为的风险并加强预防创新：我们的研究是创新的，因为它将独特地协同电路和基于可靠的初步数据和创新的生态瞬时评估的行为方法 NSSI/自杀和易怒、社会功能的现实评估、纵向随访以及承诺意义：我们的研究很重要，因为它解决了知识差距。关于 NSSI 和 NIMH/National 强调的首次发作 SA 的生物行为机制预防自杀行动联盟 (NAASP) 的“预防自杀优先研究议程”和 2016 年 6 月 NIMH 主办的“自杀风险机制”会议——因为这些机制提供了为 NSSI 和自杀的基于生物学机制的分类和治疗奠定了基础。