Risk and resilience to late-life suicidal ideation and behavior after spousal bereavement: Targeting social connectedness to strengthen circadian rhythmicity

丧偶后晚年自杀意念和行为的风险和复原力：以社会联系为目标，加强昼夜节律

• 批准号: 10722523
• 负责人: Sarah T Stahl
• 金额: $ 78.66万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10722523
• 关键词: Acute; Adult; Age; Behavior; Behavioral; Behavioral Mechanisms; Bereavement; Biological; Cessation of life; Circadian Rhythms; Clinical; Clinical assessments; Data; Dimensions; Disease remission; Distress; Elderly; Enrollment; Event; Feeling; Feeling suicidal; Hour; Individual; Intervention; Investigation; Investigational Therapies; Life; Life Style; Loneliness; Measures; Mediator; Mental Depression; Methods; Natural experiment; Participant; Pathway interactions; Pattern; Periodicity; Persons; Phase; Recording of previous events; Research; Rest; Risk; Risk Factors; Self Care; Sleep; Social Change; Socialization; Spouses; Statistical Models; Suicide; Suicide attempt; Testing; Time; Widow; Widowhood; Withdrawal; acceptability and feasibility; actigraphy; aged; biobehavior; circadian; depressive symptoms; design; digital health; experience; geriatric depression; high dimensionality; human old age (65+); ideation; improved; individual variation; longitudinal design; mortality; person centered; prospective; reducing suicide; resilience; sex; sleep onset; sleep pattern; social; social integration; social stressor; suicidal; suicidal behavior; suicidal morbidity; suicidal risk; therapy development

PROJECT SUMMARY / ABSTRACT Our past research has demonstrated that feelings of social disconnectedness and conflictual relationships are factors that often undermine deterrents to suicide. Experiencing the death of a spouse or life partner is a profoundly distressing event that may cause abrupt changes in one’s daily routine, including decreased self- care and withdrawal from social activities. While most individuals adapt over time, a substantial number of older bereaved spouses (20-35%) experience depression, loneliness, suicidal thoughts, and early mortality, including death by suicide. Thus, late-life spousal bereavement provides a “natural experiment” in which to study the impact of a well-defined and common social stressor on suicide risk in late life. The objective of this R01 application is to examine the risk for and resilience to late-life suicide during the early spousal bereavement period by investigating the extent to which (1) social connectedness influences suicide risk and (2) whether circadian rhythm instability (inconsistent patterns of sleep, activity, meals, and socialization) helps explain this association. We will enroll 169 spousally-bereaved adults aged 65 years or older, who currently have at least subthreshold symptoms of depression or have a history of depression and/or suicide attempt. We will include participants early after spousal death: during the first six months post loss. All participants will complete repeated assessments over 12 months of multiple dimensions of social connectedness, clinical assessments (depression and suicide ideation), and objective assessments of circadian rhythmicity (actigraphy-derived 24-hour patterns of rest/activity, sleep onset and timing, and circadian phase advances or delays). Thus, we will be able to investigate whether circadian rhythmicity and delayed sleep onset and timing will be associated with higher suicide risk. Participants will also complete a behavioral probe, designed to promote self-care behaviors in older bereaved spouses (called “WELL” or Widowed Elders’ Lifestyle After Loss), a digital health intervention. WELL targets the timing and regularity of social activities, sleep, and meals to determine whether modifying social connectedness reduces suicide risk and whether circadian rhythm stability explains part of this association. Preliminary data indicate that WELL increases both (a) stability of circadian rhythms (i.e., regular sleep, activity, meals, and socialization) and (b) social connectedness. We will take full advantage of our longitudinal design and repeated assessments by using high-dimensional statistical models to examine how longitudinal change in multiple dimensions of social connectedness relates to change in circadian rhythm stability as a possible biobehavioral mechanism, and whether it directly and/or indirectly effects suicide risk in late-life. The proposed research aligns with RFA MH-22-135 by identifying (1) “mechanisms by which social disconnection confers risk for, and social integration protects against suicidal thoughts and behaviors in late life;” and (2) ”biological and behavioral mechanisms that can be targets within an experimental therapeutic approach of intervention development.”

项目概要/摘要 我们过去的研究表明，社会脱节和冲突关系的感觉是 经历配偶或生活伴侣的死亡往往是削弱自杀威慑力的一个因素。 令人深感痛苦的事件，可能会导致一个人的日常生活突然发生变化，包括自我意识下降 虽然大多数人随着时间的推移会适应并退出社交活动。 失去亲人的年长配偶（20-35%）经历抑郁、孤独、自杀念头和过早死亡， 因此，晚年丧偶提供了一个“自然实验”。 研究明确且常见的社会压力源对晚年自杀风险的影响。 R01申请是为了检查配偶早期期间晚年自杀的风险和恢复力 通过调查 (1) 社会联系对自杀风险的影响程度以及 (2) 昼夜节律不稳定（睡眠、活动、进餐和社交模式不一致）是否有帮助 我们将招募 169 名 65 岁或以上的失去配偶的成年人，他们目前是该协会的成员。 至少有抑郁症的亚阈值症状或有抑郁症和/或自杀企图的病史。 将包括配偶去世后早期的参与者：在失去配偶后的前六个月内，所有参与者都将包括在内。 在 12 个月内完成对社会联系、临床等多个维度的重复评估 评估（抑郁和自杀意念）以及昼夜节律的客观评估 （体动记录仪得出的 24 小时休息/活动模式、睡眠开始和时间、以及昼夜节律阶段提前或 因此，我们将能够研究昼夜节律是否与睡眠开始和时间延迟有关。 与较高的自杀风险相关，参与者还将完成一项行为调查，旨在 促进年长失去亲人的配偶的自我照顾行为（称为“WELL”或丧偶长者的生活方式） WELL 的目标是社交活动、睡眠和膳食的时间和规律 确定改变社会联系是否会降低自杀风险以及昼夜节律是否会降低 稳定性解释了这种关联的一部分。初步数据表明，WELL 提高了 (a) 稳定性。 昼夜节律（即规律的睡眠、活动、进餐和社交）和 (b) 社交联系。 充分利用我们的纵向设计和使用高维统计的重复评估 模型来研究社会联系的多个维度的纵向变化如何与变化相关 昼夜节律稳定性作为一种可能的生物行为机制，以及是否直接和/或间接 拟议的研究与 RFA MH-22-135 一致，确定了 (1) “社会脱节给自杀带来风险，社会融合则防止自杀的机制 晚年的思想和行为；以及（2）“可以作为目标的生物和行为机制” 干预开发的实验性治疗方法。”