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，27% 的老年人因重度抑郁症和抑郁症住院治疗。 自杀倾向 出院三个月后继续报告自杀意念（SI）。拥有持久的后 出院 SI 使个人面临自杀行为和死亡的极高风险。认知和情感 机制可能决定出院后 SI 的进程，但中断这些过程仍然存在 具有挑战性的。这在一定程度上是因为上游可改变的风险因素加剧了问题 人们对出院后的认知、情感和 SI 知之甚少。我们建议睡眠-觉醒 干扰可能是影响出院后预后的重要因素。睡眠-觉醒障碍 可能会影响 SI 背后的认知和情感机制。但许多潜在相关 睡眠-觉醒因素已被确定，但尚无证据表明哪些因素标志着或驱动了睡眠-觉醒因素。 出院后使 SI 持续存在的机制。为了开始填补这些空白，我们提出了一个前瞻性的 观察性试点研究，检查睡眠-觉醒障碍以及其他假定的自杀危险因素， 出院后的关键时期。该探索性/开发性研究 (R21) 提案汇集了 睡眠-觉醒节律和晚年抑郁症专家（Smagula，博士，PI）、睡眠医学（Buysse，MD）、晚年 生命自杀（Szanto，医学博士，Co-I）、认知衰老（巴特斯，博士）和时间序列分析（Krafty，博士，Co-I）。 我们将在 12 周内监测 70 名成年人（年龄 55-75 岁，非精神病专业）的自杀倾向过程。 抑郁症、当前活动性 SI 以及最近精神病院出院）。在 6 周内，我们将 执行高分辨率数据收集，包括： 评估 24 小时睡眠-觉醒模式（使用体动记录仪和 日记）;测量每日自杀水平（被动意念、主动意念和计划）和情感（抑郁 和焦虑）；每周对先前与睡眠相关的认知功能进行家庭测试 和自杀（即注意力、反应抑制和逆转学习表现）。我们可检验的假设 基于现有证据的是：（1）每周测量短睡眠时间和睡眠-觉醒节律 中断将暂时先于并独立预测出院后 SI 的更糟过程；和（2） 这些睡眠-觉醒因素将与 SI 的进程相关，部分是通过它们对认知和情感的不利影响。 鉴于它们的重要作用，我们还将评估心理社会因素的影响并评估其 与睡眠的关系。收集这些新颖的数据将有助于分析：(1) 对影响大小进行排序 假定的危险因素，包括睡眠-觉醒、心理社会、情感和认知测量； (2) 检验 风险因素之间的时间关系； (3)中介模型的初步检验。结果由此 研究将为验证性研究的发展提供信息，最终导致新颖的、基于证据的、 干预措施。如果睡眠-觉醒因素在确定出院后自杀风险中发挥作用，那么 鉴于出院后可以改变和/或监测睡眠-觉醒风险，临床转化率很高。