Improving the Assessment of Pre-Teen Suicidal Thoughts and Behaviors in the Pediatric Emergency Department

改进儿科急诊科对青少年自杀想法和行为的评估

• 批准号: 10663532
• 负责人: David Pagliaccio
• 金额: $ 51.34万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10663532
• 关键词: 17 year old; Accident and Emergency department; Acute; Adolescence; Adolescent; Adult; Age; Autopsy; Biological; Cause of Death; Clinical assessments; Corpus striatum structure; Disease susceptibility; Distal; Dopamine; Ecological momentary assessment; Emotional; Emotions; Exhibits; Feeling suicidal; Impulsivity; Individual; Insula of Reil; Interview; Length of Stay; Life; Magnetic Resonance Imaging; Measures; Mental Depression; Midbrain structure; National Institute of Mental Health; Pathway interactions; Proxy; Public Health; Research Priority; Rewards; Risk; Risk Marker; Sampling; Stress; Suicide; Suicide attempt; System; Testing; Theoretical model; Work; Youth; child depression; experience; follow-up; high risk; high-risk adolescents; improved; in vivo; innovation; multimodality; negative mood; neural; neural circuit; neuroimaging; neuromechanism; neuromelanin; novel; pediatric emergency; peer; preadolescence; prospective; recruit; response; social; social stress; stressor; suicidal adolescent; suicidal behavior; suicidal risk; suicide attempter; suicide model

Project Summary Suicide is a major public health crisis and, currently, is the second leading cause of death among 10-24- year-olds. Suicidal thoughts and behaviors (STB) increase drastically during adolescence and are particularly common among depressed adolescents. However, definitive markers to identify which depressed adolescents are most at-risk for suicidal behaviors have not been developed. Innovative, multimodal studies probing biological and socioemotional mechanisms may elucidate potential targets to improve prediction of youth suicide and reduce the needless loss of life. Current diathesis-stress models of STB posit interactions between distal diatheses that predispose individuals to STB and proximal stressors, particularly social rejection and interpersonal loss. Recent reviews highlight potential neural diatheses for STB, yet findings are limited, particularly for high-risk adolescents. The current project targets three distal neural mechanisms–dopaminergic, social, and inhibitory deficits–in a sample of 14-17-year-old adolescents: depressed adolescents either suicidal ideation (n=55) or a recent suicide attempt (n=55) and demographically matched healthy controls (n=35). First, post-mortem work has implicated dopaminergic deficits in adult suicide, but examining dopamine function in vivo is critical to understand prospective risk for adolescent STB. Thus, we will leverage a novel Magnetic Resonance Imaging (MRI) acquisition sensitive to neuromelanin as a non-invasive proxy for dopamine in key midbrain projection regions. Given the contribution of dopamine to reward and anhedonic deficits in depression, we hypothesize that dopaminergic reductions will be prominent in adolescent STB, particularly among attempters. Second, suicide attempters experience more interpersonal stress than ideators, and thus, the proposed project will clarify whether alterations in social processing neural circuitry confer heightened risk for suicidal behaviors. We hypothesize that, during an ecologically valid Chatroom MRI task, attempters will exhibit blunted striatal response to acceptance and increased insula response to rejection by same-age peers relative to ideators. Third, negative urgency, the tendency to act impulsively following negative emotions, is implicated in adolescent suicidal behaviors. We hypothesize that attempters will exhibit frontal, striatal, and insular inhibition deficits during an emotional Go/No-Go MRI paradigm, following a social-evaluative stressor to induce a negative mood state. Adolescent ideators and attempters will be recruited from a pediatric emergency department and followed for a high-risk 3-month period, as 10% of adolescents will attempt suicide within 90 days of hospital discharge. Interpersonal stress will be characterized over follow-up via prospective ecological momentary assessment and in-depth retrospective interviews. Collectively, these novel multimodal MRI and stress measures hold great promise to elucidate the pathway to adolescent suicidal behaviors, a key NIMH research priority.

项目摘要 自杀是主要的公共卫生危机，目前是10-24-中的第二大死亡原因 一岁的孩子。自杀思想和行为（STB）在青春期期间急剧增加，尤其是 在沮丧的青少年中常见。但是，确定哪个沮丧的青少年的确定标记 尚未开发出最高风险的自杀行为。创新的多模式研究探测 生物和社会情感机制可能会阐明潜在的目标以改善青年自杀的预测 并减少不必要的生命损失。 远端核心之间的STB阳性相互作用的当前透明的透明症状模型 个人到STB和近端压力源，尤其是社会拒绝和人际交往损失。最近评论 强调了STB的潜在神经素质，但发现受到限制，尤其是对于高危青少年。 当前的项目针对三种远端神经机制 - 多巴胺能，社会和抑制性缺陷 - 14-17岁青少年的样本：沮丧的青少年自杀想法（n = 55）或最近的自杀 尝试（n = 55）和人口统计匹配的健康对照（n = 35）。首先，验尸工作已经实施 成人自杀中的多巴胺能防御措施，但在体内检查多巴胺功能对于理解至关重要 青少年STB的预期风险。那就是我们将利用一种新型的磁共振成像（MRI） 对神经苯胺敏感的采集是关键中脑投射区域中多巴胺的非侵入性代理。 鉴于多巴胺对奖励和Anhedonic在抑郁症中的贡献，我们假设 在青少年STB中，尤其是在Attempter中，多巴胺能减少将是显着的。第二，自杀 与想法者相比，示威者的人际压力更大，因此，拟议的项目将澄清是否是否存在 社会处理神经回路会议的改变增加了自杀行为的风险。我们假设 在生态有效的聊天室MRI任务中，Attempters将使纹状体的反应暴露于 接受并增加了同龄人相对于思想的同龄人对拒绝的反应。第三，负面 紧迫性，冲动遵循负面情绪的趋势与青少年自杀有关 行为。我们假设Attempter会在额叶，纹状体和抑制中暴露在 情感上的GO/No-Go MRI范式之后，遵循社会评估的压力源，诱发了负面情绪状态。 青少年的构思和招待会将从儿科急诊室招募，然后 在3个月的高风险中，由于10％的青少年将在出院后的90天内自杀。 通过前瞻性生态瞬时评估和 深入回顾性访谈。总的来说，这些新颖的多模式MRI和压力度量很大 有望阐明青少年自杀行为的途径，这是NIMH的关键研究优先级。