Physiologic Stress and Epigenetic Mechanisms that Precipitate Risk for Suicidal Behavior in Nurses

导致护士自杀行为风险的生理压力和表观遗传机制

基本信息

批准号：
10662820
负责人：
Allison Andreno Norful
金额：
$ 19.19万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-06-15 至 2028-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10662820
关键词：
Academy Age Alleles Autopsy Biological Biological Markers Blood Cessation of life Characteristics Chronic stress Clinical Complement Corwin Cross-Sectional Studies DNA Methylation Data Data Analyses Decision Making Development Discipline of Nursing Discrimination Disease susceptibility Diurnal Rhythm Divorce Environment Environmental Exposure Environmental Risk Factor Epigenetic Process Exposure to Feeling suicidal Funding Gambling Gender General Population Genes Genetic Genetic Risk Goals Grant Growth Hair Health Healthcare Household Hydrocortisone Income Individual Investigation Iowa Lateral Life Link Longitudinal Studies Marital Status Measurement Measures Mediating Medicine Mentors Mentorship Methylation Modeling Moods Nurses Occupational Patient Self-Report Pharmaceutical Preparations Physician-Nurse Relations Physicians Physiological Precipitating Factors Predisposing Factor Production Psychiatric Diagnosis Psychological Interview Psychopathology Public Health Race Reporting Research Risk Factors Saliva Sample Size Series Serum Sleep Smoking Smoking History Statistical Models Stress Stressful Event Suicide Suicide attempt Suicide prevention Surveys Testing Time Training Training Programs Trauma United States Violence Work Workload biological adaptation to stress demographics experience genome-wide high risk high risk population hypothalamic-pituitary-adrenal axis instrument lifestyle factors longitudinal analysis longitudinal design loved ones perceived stress power analysis preventive intervention professional atmosphere programs protective factors recruit response sex shift work sleep health social cognition stress reactivity stressor study characteristics substance use suicidal behavior suicidal individual suicidal risk suicide model suicide rate

项目摘要

PROJECT SUMMARY/ABSTRACT The rate of suicide in nurses has reached alarming proportions, with recent estimates upward of 17.1 suicides per 100,000 nurses each year—almost double that of the general population (8.6/100,000). Proposed is a program of training and research using longitudinal design to investigate the associations among individual (e.g., subjective mood, lifetime trauma) and work environment characteristics (e.g., shift type and duration); life stressors (e.g., discrimination, lateral violence); and suicidal ideation or behavior in nurses. Whereas previous research about suicide in nurses has been limited to postmortem data, cross-sectional studies or self-report stress measures, the proposed project will collect longitudinal data and will use physiologic stress biomarkers (hair cortisol) and epigenetics (DNA methylation) to better establish the temporal sequence of potential nursing-specific risk factors (individual characteristics, life stressors, physiologic stress, and work environment characteristics), and suicidal ideation or behavior in real-world clinical settings. Sleep will be tested as a potential modifiable protective factor, as will nurse work environment characteristics (e.g., day vs. night shift). Hair cortisol concentrations measure cumulative cortisol release and reflect past months of stress exposure, thus avoiding diurnal variation effects and permitting the longitudinal investigation of real-world individual and environmental exposures. Grounded in the Stress-Diathesis Model of Suicidal Behavior, we will recruit 100 nurses to undergo a series of psychological interviews (e.g., SCID-5-RV and Iowa Gambling Task), quantitative survey measures using validated instruments, and hair cortisol concentrations every 3 months for 1 year. Further, we will explore genome-scale epigenetic mechanisms that potentiate harmful DNA methylation on unique gene alleles, which exacerbate suicidal ideation or behavior and can potentially help us to better understand genetic expression of stress adaptation in the search for biological mechanisms. We aim to identify modifiable individual and work environment characteristics that could mitigate suicidal ideation or behavior, even for those at high genetic risk. We will use a range of analytical strategies selected to test interactions and moderating effects including latent growth curve modeling. The proposed research will be complemented by experiential and didactic training, along with expert mentorship in the fields of (1) physiologic stress measurement, (2) suicidology, (3) epigenetics/DNA methylation, (4) longitudinal analysis, and (5) professional development and dissemination of findings. Results of this K08 application will yield data needed to inform final variables and measures and a power analysis for a planned R01 submission in Year 5 that proposes a large- scale longitudinal study in nurses. Overall, this K08 funding would support my path to research independence and my overall goal of building evidence to better identify high-risk individuals for suicide and to inform the development of individualized suicide prevention interventions in nurses and similar frontline workforce.

项目概要/摘要护士的自杀率已达到惊人的比例，最近估计自杀人数高达 17.1 每年每 100,000 名护士的比例几乎是总人口的两倍 (8.6/100,000)。使用纵向设计来调查个体之间关联的培训和研究计划（例如主观情绪、一生创伤）和工作环境特征（例如轮班类型和持续时间）；压力源（例如歧视、横向暴力）；以及护士的自杀意念或行为。关于护士自杀的研究仅限于尸检数据、横断面研究或自我报告压力测量，拟议项目将收集纵向数据并使用生理压力生物标志物（头发皮质醇）和表观遗传学（DNA 甲基化）更好地建立潜力的时间序列护理特定危险因素（个人特征、生活压力源、生理压力和工作环境特征），以及现实临床环境中的自杀意念或行为。潜在的可改变的保护因素，以及护士工作环境特征（例如，白班与夜班）。头发皮质醇浓度测量累积皮质醇释放并反映过去几个月的压力暴露，从而避免昼夜变化的影响，并允许对现实世界的个体和基于自杀行为的压力素质模型，我们将招募 100 名参与者。护士接受一系列心理访谈（例如 SCID-5-RV 和爱荷华州赌博任务），使用经过验证的仪器进行定量调查，每 3 个月测量一次头发皮质醇浓度此外，我们将探索增强有害 DNA 甲基化的基因组规模表观遗传机制。独特的基因等位基因，这会加剧自杀意念或行为，并可能帮助我们更好地我们的目标是确定应激适应的基因表达的生物学机制。可改变的个人和工作环境特征，可以减轻自杀意念或行为，即使对于那些具有高遗传风险的人，我们也会使用一系列选定的分析策略来测试相互作用和包括潜在增长曲线建模在内的调节效应将得到补充。体验式和教学式培训，以及 (1) 生理压力领域的专家指导测量，(2) 自杀学，(3) 表观遗传学/DNA 甲基化，(4) 纵向分析，以及 (5) 专业该 K08 应用程序的结果将产生最终结果所需的数据。变量和措施以及对第 5 年计划的 R01 提交的功效分析，其中提出了一个大的总体而言，这笔 K08 资金将支持我走向独立研究的道路。我的总体目标是建立证据以更好地识别自杀高危人群并告知对护士和类似的一线工作人员制定个性化的自杀预防干预措施。