Toward Optimizing Behavioral Markers of Suicide Risk

优化自杀风险的行为标志

• 批准号: 9352263
• 负责人: SEAN BARNES
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9352263
• 关键词: Address; Anxiety; Area; Behavioral; Cessation of life; Clinical; Clinical assessments; Cognition; Cognitive; Communities; Conscious; Cues; Development; Diagnosis; Disease; Disease susceptibility; Distress; Emotions; Evaluation; Feeling suicidal; Fostering; Future; Implicit Association Test; Individual; Inpatients; Intervention; Interview; Knowledge; Lead; Life Stress; Link; Measurement; Measures; Mental Health; Methodology; Methods; Modeling; Moods; Participant; Patient Self-Report; Patient observation; Patient risk; Patients; Population; Procedures; Process; Psychopathology; Reaction Time; Recording of previous events; Reporting; Research; Research Personnel; Risk; Risk Assessment; Risk Factors; Risk Marker; Sampling; Severities; Stimulus; Stress; Structure; Suicide; Suicide attempt; Suicide prevention; Testing; Theoretical model; Thinking; Time; Trauma; Unconscious State; Validation; Veterans; attentional bias; behavior measurement; clinical practice; cognitive process; cohesion; computerized; design; experience; follow-up; health administration; high risk; improved; information processing; insight; movie; novel; resilience; stressor; suicidal; suicidal behavior; suicidal individual; suicidal morbidity; suicidal risk; suicide model; theories

Despite ongoing efforts to enhance suicide risk assessment, current methods rely heavily on patient report of suicidal ideation and related factors (e.g., intent, plan, access to means) to determine level of risk. Reliance on self-report is problematic because many patients are unwilling or unable to report thoughts and intentions of suicide.1 In addition to these limitations, the emphasis of self-report measures on conscious thoughts and emotions has fostered little insight into the largely unconscious cognitive processes that are theorized to underlie suicidal crises.2,3 These suicide-related cognitive processes, or habitual ways of thinking that promote suicide, are believed to emerge when individuals become distressed, but at other times may be dormant. This notion of “suicidal cognitive reactivity” is consistent with clinicians’ and patients’ observations that for some individuals suicidal thoughts and intentions may be absent during a clinical interview, but then rapidly resurface in the presence of distress. Although suicidal cognitive reactivity is purported to be a critical underlying mechanism of suicide risk, it has received little empirical evaluation because there have not been any established procedures to elicit and assess it. The ability to elicit and assess suicidal cognitive reactivity could be extremely clinically useful. If clinicians could assess the likelihood of suicidal thoughts and intentions emerging in the near future, they would be better able to accurately determine patients’ risk of suicide. We have developed and pilot tested a procedure to evaluate suicidal cognitive reactivity using a suicide-specific mood induction and computerized reaction-time tasks (i.e., the Death/Suicide Implicit Association Test,4 and the Suicide Stroop5) that implicitly measure cognitive processes (i.e., association of self with death, and biased attention toward suicide-related cues) and have predicted suicide attempts among high-risk civilians and Veterans.4,6,7 These tasks serve as behavioral markers of suicide risk. Although promising, the tasks are still not very accurate. This may be due to suicide-related cognitive processes not being active in some participants at the time of assessment. In order to optimize the tasks and test the critical theoretical prediction that distress activates suicidal thinking, the proposed research will examine scores on the Death/Suicide Implicit Association Test and Suicide Stroop task both before and after inducing a dysphoric mood in participants by having them watch a brief scene from a movie having to do with suicide. The study will compare two groups of Veterans: (1) a “Suicide Group” who have or have had a mood anxiety and/or trauma related disorder and have attempted suicide within the past year, and (2) a “No Suicide Group” who similarly have or have/had a mood anxiety and/or trauma related disorder, but have never seriously considered attempting suicide. If the cognitive theory of suicidal behavior2,3 is correct, the Suicide Group will display a significantly larger increase in suicide-related cognitive processes following the mood induction than any increase displayed by the No Suicide Group. Six-months later, participants will complete an interview to determine if they have attempted suicide since the initial assessment session. If utilizing our suicide-specific mood induction does optimize the accuracy of these tasks, the post-mood induction scores from the initial assessment session should predict suicide attempts over and above the pre-mood induction scores and other common indicators of suicide risk (e.g., mental health diagnosis, patient prediction, severity of suicidal ideation). The ability to objectively assess latent processes underlying both suicide risk and resilience among Veterans could significantly contribute to Veterans Health Administration efforts to prevent suicide. Furthermore, results of the proposed study, testing a critical component of one of the field’s most prominent models of suicidal behavior, would inform future research on when, why, and how Veterans are at risk for suicide.

尽管正在进行努力增强自杀风险评估，但当前方法在很大程度上取决于患者的报告 自杀思想和相关因素（例如，意图，计划，获得含义）以确定风险水平。依靠 自我报告是有问题的，因为许多患者不愿意或无法报告 1自杀。除这些局限性外，强调自我报告措施对有意识的思想和 情绪几乎没有洞察力对大量无意识的认知过程的见解，这些过程被理论化为 自杀犯罪的基础。2,3这些与自杀有关的认知过程或促进的习惯性思维方式 自杀时，人们认为当个人感到沮丧时会出现，但在其他时候可能处于休眠状态。这 “自杀认知反应性”的概念与临床医生和患者的观察一致，这些观察结果是 在临床访谈中，个人可能不存在自杀思想和意图，但随后迅速度假 在遇到困境的情况下。尽管自杀的认知反应性被认为是关键的基础 自杀风险机制，它几乎没有经验评估，因为没有任何 建立的程序来引发和评估它。引发和评估自杀认知反应的能力可以 在临床上非常有用。如果临床医生可以评估自杀思想和意图的可能性 在不久的将来，他们将能够更好地确定患者自杀的风险。我们 已经开发和试点测试了一种使用自杀特异性评估自杀认知反应性的程序 情绪吸引和计算机化反应时间任务（即死亡/自杀隐式协会测试，4和 自杀的stroop5）隐式测量认知过程（即自我与死亡的关联和有偏见 注意与自杀有关的提示），并预测了高风险平民的自杀企图 退伍军人4,6,7这些任务是自杀风险的行为标志。尽管很有希望，但任务仍然是 不是很准确。这可能是由于自杀相关的认知过程在某些参与者中不活跃 在评估时。为了优化任务并测试困扰的关键理论预测 激活自杀思维，拟议的研究将检查有关死亡/自杀的分数 协会测试和自杀率stroop任务在引起参与者的烦躁情绪之前和之后 让他们观看电影中的简短场景与自杀有关。该研究将比较两组 退伍军人：（1）有或患有情绪动画和/或创伤有关的“自杀群体” 在过去的一年中尝试自杀，（2）一个同样拥有或拥有/有一个的“无自杀群体” 情绪动画和/或与创伤有关的障碍，但从未认真考虑过自杀。如果是 自杀行为的认知理论2,3是正确的，自杀群将显示出明显更大的增加 情绪引起的自杀相关的认知过程比NO所显示的任何增加 自杀组。六个月后，参与者将完成面试，以确定他们是否尝试过 自初次评估会议以来自杀。如果使用我们的自杀特异性情绪诱导确实可以优化 这些任务的准确性，初始评估课程的MOOD后感应分数应预测 自杀企图超出MOOD归纳分数和自杀风险的其他常见指标 （例如，心理健康诊断，患者预测，自杀想法的严重程度）。客观评估的能力 退伍军人之间自杀风险和韧性的潜在过程可能会大大贡献 退伍军人卫生管理局为防止自杀而做出的努力。此外，拟议的研究的结果，测试 该领域最突出的自杀行为模型之一的关键组成部分，将为未来提供信息 研究何时，为什么以及退伍军人有自杀的风险。