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.”

项目摘要 /摘要 我们过去的研究表明，社会脱节和冲突关系的感觉是 通常破坏自杀的因素。体验配偶或生活伴侣的死亡是 令人痛苦的事件可能会导致每日常规的突然变化，包括自我减少 照顾和退出社交活动。虽然大多数人会随着时间的流逝而适应 较老的丧亲配偶（20-35％）经历抑郁，孤独，自杀思想和早期死亡率， 包括自杀死亡。那是晚年的配偶丧亲提供了一个“自然实验” 研究一个定义明确的社会压力源对后期自杀风险的影响。这个目的 R01的应用是在早期配偶期间检查对后期自杀的风险和韧性 丧亲期通过调查（1）社会联系影响自杀风险和 （2）昼夜节律不稳定性（睡眠，活动，进餐和社交状态不一致）是否有帮助 解释这个关联。我们将注册169名65岁或65岁以上的成年人，目前 至少有抑郁症的阈值症状，或者有抑郁症和/或自杀的史。我们 配偶死亡后将包括参与者：损失后的头六个月。所有参与者都会 在12个月的社会联系，临床上的多个维度的12个月内完成重复评估 评估（抑郁和自杀想法）和昼夜节律的客观评估 （行动学衍生的24小时休息/活动，睡眠发作和时机以及昼夜节律的进步或 延迟）。那我们将能够调查昼夜节律的节奏和延迟的睡眠开始和时机 将与更高的自杀风险有关。参与者还将完成旨在的行为调查 促进较老的丧亲配偶的自我保健行为（称为“井”或丧偶长者的生活方式 损失），一种数字健康干预。井针对社交活动，睡眠和餐点的时间和规律性 确定修改社会联系是否会降低自杀风险以及昼夜节律是否会降低 稳定性解释了该关联的一部分。初步数据表明，井（a）的稳定性 昼夜节律（即定期睡眠，活动，餐和社交化）和（b）社会联系。我们将 通过使用高维统计来充分利用我们的纵向设计和重复评估 模型检查与变化有关的社会联系多个维度的纵向变化 在昼夜节律稳定性中，作为可能的生物行为机制，以及它是否直接和/或间接 影响后期的自杀风险。提出的研究通过识别（1）来与RFA MH-22-135保持一致 “社会脱节承认风险的机制，而社会融合可以防止自杀 晚年的思想和行为；” （2）“可以是目标的生物学和行为机制 干预开发的实验治疗方法。”