Sleep-wake, cognitive, and affective risks for a worse course of post-discharge suicidal ideation in older adults with major depression

患有重度抑郁症的老年人出院后自杀意念恶化的睡眠-觉醒、认知和情感风险

• 批准号: 9974894
• 负责人: Stephen F Smagula
• 金额: $ 43.04万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9974894
• 关键词: Address; Adult; Adverse effects; Affect; Affective; Affective Symptoms; Age; Anxiety; Architecture; Attention; Butter; Cessation of life; Characteristics; Cognition; Cognitive; Cognitive aging; Data; Data Collection; Data Set; Depression and Suicide; Development; Distal; Doctor of Philosophy; Elderly; Evidence based intervention; Feeling suicidal; Future; Goals; Home environment; Hour; Impaired cognition; Individual; Interruption; Link; Major Depressive Disorder; Measures; Mediating; Medicine; Mental Depression; Modeling; Monitor; Neurobehavioral Manifestations; Outcome; Pathway interactions; Pattern; Performance; Pilot Projects; Prevention approach; Process; Psychiatric Hospitals; Psychosocial Factor; Questionnaires; Reporting; Research; Resolution; Reversal Learning; Risk; Risk Assessment; Risk Factors; Risk Marker; Role; Series; Severities; Shapes; Signal Transduction; Sleep; Suicide; Suicide prevention; Testing; Time; Training; Treatment/Psychosocial Effects; actigraphy; base; clinical application; clinical translation; cognitive function; cognitive performance; cognitive testing; data archive; diaries; evidence base; geriatric depression; high risk; ideation; inpatient psychiatric treatment; inpatient service; modifiable risk; novel; novel strategies; outcome forecast; prospective; psychosocial; response; suicidal behavior; suicidal morbidity; suicidal risk; young adult

Abstract: Our archival data indicates that 27% of older adults hospitalized with major depression and suicidality continue to report suicidal ideation (SI) three months after discharge. Having persistent post- discharge SI places individuals at very high risk for suicidal behaviors and death. Cognitive and affective mechanisms likely determine the course of post-discharge SI, but interrupting these processes remains challenging. This is, in part, because the upstream modifiable risk factors that exacerbate problems with cognition, affect, and SI in the post-discharge period are poorly understood. We propose that sleep-wake disturbances are potentially important contributors to the post-discharge prognosis. Sleep-wake disturbances plausibly influence the cognitive and affective mechanisms that underlie SI. But many potentially relevant sleep-wake factors have been identified, and there is not yet evidence regarding which mark or drive the mechanisms that perpetuate SI after discharge. To begin filling these gaps, we propose a prospective observational pilot study examining sleep-wake disturbances, alongside other putative suicide risk factors, in the critical post-discharge period. This Exploratory/Developmental Research (R21) proposal brings together experts in sleep-wake rhythms and late-life depression (Smagula, PhD, PI), sleep medicine (Buysse, MD), late- life suicide (Szanto, MD, Co-I), cognitive aging (Butters, PhD), and time series analytics (Krafty, PhD, Co-I). We will monitor the course of suicidality over 12-weeks in 70 adults (age 55-75, with non-psychotic major depressive disorder, current active SI, and a recent psychiatric hospital discharge). Over 6 weeks, we will perform high-resolution data collection including: assessing 24-hour sleep-wake patterns (using actigraphy and diary); measuring daily suicidality levels (passive ideation, active ideation, and planning) and affect (depression and anxiety); and administering weekly home-based tests of cognitive functions previously linked with sleep and suicide (i.e., attention, response inhibition, and reversal learning performance). Our testable hypotheses based on existing evidence are that: (1) weekly measures of short sleep duration and sleep-wake rhythm disruption will temporally precede and independently predict a worse course of post-discharge SI; and (2) these sleep-wake factors will relate to the course of SI, in part, via their adverse effects on cognition and affect. Given their important roles, we will also evaluate the effects of psychosocial factors and assess their relationships with sleep. Collecting these novel data will enable analyses: (1) ranking the effect sizes of putative risk factors including sleep-wake, psychosocial, affective, and cognitive measures; (2) examining the temporal relationships between risk factors; and (3) preliminarily testing mediational models. Results from this study will inform the development of confirmatory studies ultimately leading to novel, evidence-based, interventions. If sleep-wake factors have a role in determining post-discharge suicide risk, the potential for clinical translation is high, given that sleep-wake risks could be modified and/or monitored after discharge.

摘要：我们的档案数据表明，有27％的老年人住院，患有严重抑郁症和 出院三个月后，自杀性继续报告自杀意念（SI）。持续存在 出院SI使个人对自杀行为和死亡的风险很高。认知和情感 机制可能决定了分娩后SI的过程，但中断这些过程仍然存在 具有挑战性的。这部分是因为上游可修改的风险因素加剧了问题的问题 在入院期间，认知，情感和SI的理解很少。我们建议睡觉 干扰可能是入院后预后的重要贡献者。睡眠唤醒 合理地影响了基于SI的认知和情感机制。但是许多潜在的相关 已经确定了睡眠效果因素，并且尚无证据表明哪个标记或驱动 出院后会使Si永久存在的机制。为了开始填补这些空白，我们提出了一个潜在的 观察性试验研究检查睡眠觉醒障碍，以及其他推定的自杀危险因素， 关键的后收费期。这项探索/发展研究（R21）提案汇集了 睡眠唤醒节奏和晚期抑郁症的专家（Smagula，PhD，PI），睡眠医学（Buysse，MD），晚期 - 生命自杀（Szanto，MD，Co-I），认知衰老（Butters，PhD）和时间序列分析（Krafty，PhD，Co-I）。 我们将监视70名成年人超过12周（55-75岁，非精神病学专业）的自杀过程 抑郁症，当前活跃的SI和最近的精神病医院出院）。超过6周，我们将 执行高分辨率数据收集，包括：评估24小时睡眠效果模式（使用Actraphy和 日记）;测量每日自杀级别（被动构想，主动构想和计划）并影响（抑郁症 和焦虑）；并管理以前与睡眠相关的认知功能的每周家庭测试 和自杀（即注意，反应抑制和逆转学习绩效）。我们的可检验的假设 基于现有的证据是：（1）每周睡眠持续时间和睡眠节奏的每周度量 干扰将在时间之前之前，并独立预测更糟糕的疾病后si。 （2） 这些睡眠效果因素将通过对认知和影响的不良影响与SI的过程有关。 鉴于它们的重要作用，我们还将评估社会心理因素的影响并评估其 与睡眠的关系。收集这些新型数据将实现分析：（1）对效果大小进行排名 推定的危险因素，包括睡眠，社会心理，情感和认知措施； （2）检查 风险因素之间的时间关系； （3）初步测试中介模型。结果 研究将告知确认性研究的发展，最终导致新颖的，循证的， 干预措施。如果睡眠 - 饮用因素在确定入院后自杀风险中起作用，则可能 鉴于出院后可以修改和/或监测睡眠效果风险，临床翻译很高。