Neural Mechanisms and Predictors of an Ultra-Brief Suicide Prevention Strategy

超简短自杀预防策略的神经机制和预测因子

基本信息

批准号：
10198354
负责人：
Stephanie Gorka
金额：
$ 64.84万
依托单位：
OHIO STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-05-01 至 2026-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10198354
关键词：
Accident and Emergency department Acute Address Adopted Adult Affective Aftercare American Award Base of the Brain Behavior Behavioral inhibition Blinking Brain Cause of Death Cessation of life Chemosensitization Clinical Clinical Trials Design Cognitive Coping Behavior Data Development Distal Ecological momentary assessment Emotional Emotions Fatal Outcome Feeling suicidal Functional Magnetic Resonance Imaging Funding Mechanisms Goals Health Hour Individual Inpatients Intervention Joints Knowledge Mediating Medical Mission National Institute of Mental Health Neurobiology Neurophysiology - biologic function Neurosciences Outcome Outpatients Patient Self-Report Patients Prevalence Prevention Research Prevention strategy Primary Health Care Prognostic Marker Psychophysiology Public Health Randomized Recording of previous events Recovery Research Risk Risk Management Series Services Signal Transduction Soldier Source Strategic Planning Suicide Suicide prevention Surveys System Technology Assessment Testing Time United States Volition Volunteer Group Work brain pathway career clinical decision-making cognitive reappraisal cohort emotion regulation follow-up health care settings high risk high risk population improved indexing innovation longitudinal design multimodality neural circuit neural network neuromechanism post intervention preventive intervention programs reducing suicide relating to nervous system response stress reactivity success successful intervention suicidal suicidal behavior suicidal risk suicide model suicide rate support network translational research program treatment planning

Accident and Emergency department Acute Address Adopted Adult Affective Aftercare American Award Base of the Brain Behavior Behavioral inhibition Blinking Brain Cause of Death Cessation of life Chemosensitization Clinical Clinical Trials Design Cognitive Coping Behavior Data Development Distal Ecological momentary assessment Emotional Emotions Fatal Outcome Feeling suicidal Functional Magnetic Resonance Imaging Funding Mechanisms Goals Health Hour Individual Inpatients Intervention Joints Knowledge Mediating Medical Mission National Institute of Mental Health Neurobiology Neurophysiology - biologic function Neurosciences Outcome Outpatients Patient Self-Report Patients Prevalence Prevention Research Prevention strategy Primary Health Care Prognostic Marker Psychophysiology Public Health Randomized Recording of previous events Recovery Research Risk Risk Management Series Services Signal Transduction Soldier Source Strategic Planning Suicide Suicide prevention Surveys System Technology Assessment Testing Time United States Volition Volunteer Group Work brain pathway career clinical decision-making cognitive reappraisal cohort emotion regulation follow-up health care settings high risk high risk population improved indexing innovation longitudinal design multimodality neural circuit neural network neuromechanism post intervention preventive intervention programs reducing suicide relating to nervous system response stress reactivity success successful intervention suicidal suicidal behavior suicidal risk suicide model suicide rate support network translational research program treatment planning

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项目摘要

Close to 45,000 Americans die from suicide each year and rates have been steadily rising for the last two decades. There is an urgent need for better access to effective suicide prevention strategies that are highly transportable across medical settings. Data from the current team indicates that a single session of crisis response planning (CRP) reduces suicide behavior by 76%; however, it is unknown how CRP works, and for whom, curtailing strategy optimization and widespread implementation. Clinicians speculate that CRP works by strengthening emotion regulation capabilities and reducing stress reactivity; however, this hypothesis has never been tested and no prior study has identified neural mechanisms and predictors of changes in suicide risk following intervention. Related, there are no objective brain-based markers of ‘reduced’ suicide risk to inform clinical decision making and guide high-risk patients to needed services. To address these gaps and ultimately improve suicide prevention efforts we seek to identify brain-based mechanisms and predictors of changes in suicidality following a single session of CRP in a cohort of adults with active suicidal intent. We will take an innovative and comprehensive approach by probing stress reactivity and emotion regulation neural circuits in the context of a clinical trials design. Specifically, we will combine sources of information and simultaneously collect assessments of neural function, psychophysiology (i.e., startle eyeblink potentiation), behavior and self-report during functional magnetic resonance imaging (fMRI) before (Time 1) and after (Time 2) randomization to a single, one-hour session of CRP or standard suicide risk management (control). A small group of volunteers with no history of suicide ideation or intent will be included for comparison. Using ecological momentary assessment (EMA) technology, acute changes in suicidality following intervention will be assessed twice daily for the first week. Monthly online clinical surveys will also be administered, and at 6-months post- intervention, the entire multimodal assessment battery will be re-administered (Time 3). This innovative, multilayered, longitudinal design will allow for a well-controlled test of how a single session of CRP acutely changes suicide risk (Aim 1). The study will also address whether the acute effects of CRP are sustained over time and how neural function influences long-term changes in suicidality (Aim 2). Lastly, we will conduct sophisticated analyses to integrate data across ‘units of analysis’ and functional domains to test whether there are reliable prognostic indicators of CRP intervention success (Aim 3). Findings from this study will provide critical new knowledge regarding how an ultra-brief session of CRP works and for whom, while uncovering a mechanistic signal of reduced suicide risk. In addition, consistent with the mission of the NIMH BRAINS program, the award will facilitate the launch of the PI’s innovative translational program of research and pave the way for a series of large-scale studies aimed at identifying neurobiological targets for resolving suicide risk and testing whether interventions with effective target engagement can enhance suicide prevention outcomes.

每年近45,000名美国人死于自杀，而过去两个人的速度却在繁忙几十年。迫切需要更好地获取高度有效的自杀预防策略可以在医疗环境中运输。当前团队的数据表明一场危机会议响应计划（CRP）将自杀行为降低了76％；但是，尚不清楚CRP的工作原理，并且谁，减少策略优化和宽度实施。临床医生推测CRP可以通过增强情绪调节能力并降低压力反应性；但是，这个假设从来没有我们接受了测试，没有先前的研究确定了自杀风险变化的神经机制和预测指标干预后。相关，没有客观的基于大脑的自杀风险标记来告知临床决策和引导高危患者获得所需服务。解决这些差距，最终改善预防自杀的努力，我们试图确定基于大脑的机制和预测变化的预测因素在具有主动自杀意图的成年人队列中进行一次CRP的自杀性。我们将接受通过探测压力反应性和情绪调节神经回路的创新和全面方法临床试验设计的背景。具体来说，我们将结合信息来源，简单地收集神经功能，心理生理学的评估（即惊吓ekeikeblink增强），行为在功能磁共振成像（fMRI）（时间1）和（时间2）之前的功能磁共振成像（fMRI）期间的自我报告（时间2）随机将CRP或标准自杀风险管理或标准自杀风险管理（控制）的单个小时。一个小将包括没有自杀想法或意图史的志愿者组以进行比较。使用生态瞬时评估（EMA）技术，将评估干预后自杀的急性变化第一个星期每天两次。每月在线临床调查也将进行，并在6个月后 - 干预措施，将重新管理整个多模式评估电池（时间3）。这个创新的，多层，纵向设计将允许对单个CRP的一次敏感性进行良好的控制测试改变自杀风险（目标1）。该研究还将解决CRP的急性影响是否持续时间和神经功能如何影响自杀的长期变化（AIM 2）。最后，我们将进行复杂的分析以整合跨“分析单位”和功能域的数据，以测试是否存在是CRP干预成功的可靠预后指标（AIM 3）。这项研究的发现将提供关于CRP的超大型会议如何运作以及为之探索的关键新知识自杀风险降低的机械信号。此外，与Nimh Brains计划的任务一致，该奖项将有助于启动PI的创新翻译研究计划，并为一系列大规模研究旨在识别用于解决自杀风险和测试的神经生物学目标有效目标参与的干预措施是否可以增强自杀预防结果。