Adolescent Girls’ Risk for Suicide Across the Menstrual Cycle: Examining Stress and Negative Valence Systems Longitudinally

青春期女孩在整个月经周期的自杀风险：纵向检查压力和负价系统

• 批准号: 10132400
• 负责人: Tory Anne Eisenlohr-Moul
• 金额: $ 72.36万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 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 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10132400
• 关键词: 12 year old; Accidents; Acute; Address; Adolescence; Adolescent; Adult; Affective; Age; Anger; Anxiety; Award; Behavioral; Biological Assay; Biological Markers; Cause of Death; Characteristics; Clinical; Country; Data; Development; Diagnosis; Diagnostic Procedure; Distal; Feeling; Feeling suicidal; Female; Female Adolescents; Funding; Future; Genomics; Hormones; Hydrocortisone; Individual Differences; Interruption; Laboratories; Link; Literature; Measures; Mediating; Mediator of activation protein; Menarche; Menstrual cycle; Mental Depression; Mental disorders; Molecular; Mood Disorders; Moods; Negative Valence; Neurosciences; Ovarian hormone; Participant; Periodicity; Persons; Phase; Physiological; Procedures; Process; Psychopathology; Reporting; Research; Research Domain Criteria; Research Personnel; Risk; Risk Behaviors; Risk Factors; Sampling; Science; Severities; Shapes; Standardization; Stress; Suicide; Suicide attempt; Surveys; System; Testing; Time; United States National Institutes of Health; Visit; Woman; Work; Youth; aged; base; biological adaptation to stress; boys; depressive symptoms; design; diaries; experience; follow-up; girls; high risk; hormone sensitivity; ideation; innovation; molecular marker; mortality; negative affect; perimenstrual; predicting response; programs; proliferative phase Menstrual cycle; prospective; psychological symptom; recruit; reproductive; reproductive hormone; response; social; social stress; stress reactivity; stressor; suicidal adolescent; suicidal behavior; suicidal risk; theories; virtual

Project Summary/Abstract Suicide is the second leading cause of death (behind accidents) among those ages 10-34 years in the US and is the cause of mortality most strongly linked to mental illness. Starting at approximately age 12 years, the rate of suicidal thoughts and behaviors (STBs) increases dramatically, especially among girls, who experience STBs at twice the rate for boys. These pronounced increases for adolescents and for girls have been well-documented for decades and are seen in virtually every country/culture around the world, yet, there is no firm understanding of why they exist. Moreover, very little is known about when risk is highest. The proposed research extends our team’s prior work, funded by two prior R01 awards, examining adolescent girls’ stress responses as prospective predictors of STB trajectories, and a K99/R00 award revealing that changes in reproductive hormones across the menstrual cycle produce specific periods of high STB risk (particularly during the peri-menstrual phase) among adult women. Specifically, we hypothesize that girls will report higher occurrence and severity of STBs on days in the peri-menstrual phase than on days in other cycle phases (mid-follicular, ovulatory, mid-luteal), that these increases will be mediated by daily changes in negative affect and stress-reactivity during the peri- menstrual phase, and that girls with greater cyclical hormone sensitivity are at greater long-term risk of STBs, particularly during times when interpersonal stress is elevated. We propose to test these hypotheses in a sample of 200 clinically-referred girls ages 12-17 years who are at least one year post-menarche. The design begins with 70 days (two cycles) of daily surveys to assess negative affect and STBs. In addition, girls will complete two counterbalanced laboratory visits (at high risk peri-menstrual and low risk mid-follicular phases) during which we will evaluate their affective and physiological (autonomic, cortisol, genomic) responses to a standardized laboratory stressor. Next, girls will complete weekly surveys measuring cycle phase, interpersonal stress, negative affect, and STBs through one year of follow up. The intensive two-month baseline phase allows us to examine how the menstrual cycle shapes daily affective and physiological risk for STBs and lets us diagnose each girl’s degree of hormone sensitivity. These baseline individual differences in hormone sensitivity then can be examined as a predictor of STBs across the follow-up year of assessments, particularly during periods of elevated social stress. This powerful design will clarify whether cyclical changes in daily STBs (Aim 1) are mediated by affective and physiological STB risk factors, such as negative affect (Aim 2a; measured via daily surveys) and social stress reactivity (Aim 2b; measured via lab-based behavioral, physiological, and molecular biomarker assays), while also acknowledging critical moderation by both individual differences in hormone sensitivity (i.e., not all girls will have severe cyclical mood changes) and time-varying interpersonal stress (Aim 3). This innovative study will address several long-standing questions in the literature, including why girls are at increased risk, when girls may be most at risk, and which girls are at highest risk for future STBs.

项目概要/摘要 自杀是美国 10-34 岁人群的第二大死亡原因（仅次于事故） 是与精神疾病密切相关的死亡原因，从大约 12 岁开始，该比率就很高。 自杀念头和行为 (STB) 急剧增加，尤其是经历过 STB 的女孩 青少年和女孩的增幅是男孩的两倍，这一点已有充分记录。 几十年来，几乎在世界各地的每个国家/文化中都可以看到这种现象，但是，人们并没有明确的理解 此外，我们对何时风险最高的情况知之甚少。 团队之前的工作由之前的两个 R01 奖项资助，研究了青春期女孩的压力反应作为前瞻性 STB 轨迹的预测因素，以及 K99/R00 奖揭示了生殖激素的变化 月经周期会产生STB高风险的特定时期（特别是在围经期） 具体来说，我们敢说女孩的 STB 发生率和严重程度更高。 围经期的日子比其他周期阶段（卵泡中期、排卵期、黄体中期）的日子要多， 这些增加将通过围产期期间负面情绪和压力反应性的日常变化来调节 月经期，并且对周期性激素敏感性较高的女孩患 STB 的长期风险较高， 特别是在人际压力升高的时候，我们建议在样本中检验这些假设。 设计开始于 200 名年龄在 12-17 岁、月经初潮后至少一年的女孩中。 为期 70 天（两个周期）的每日调查来评估负面影响和 STB 此外，女孩将完成两项。 平衡实验室访视（高风险围经期和低风险卵泡中期），在此期间我们 将评估他们对标准化的情感和生理（自主、皮质醇、基因组）反应 接下来，女孩将每周完成调查，测量周期阶段、人际关系压力、 负面影响和 STB 通过一年的随访 密集的两个月基线阶段使我们能够 检查月经周期如何影响 STB 的日常情感和生理风险，并让我们进行诊断 每个女孩的激素敏感性程度可以通过这些基线个体差异来确定。 作为后续评估年度 STB 的预测因素进行检查，特别是在 这种强大的设计将澄清日常机顶盒的周期性变化（目标 1）是否是 由情感和生理 STB 风险因素介导，例如负面情绪（目标 2a；通过每日测量 调查）和社会压力反应性（目标 2b；通过基于实验室的行为、生理和分子测量 生物标志物测定），同时也承认激素个体差异的关键调节 敏感性（即并非所有女孩都会有严重的周期性情绪变化）和随时间变化的人际压力（目标 3) 这项创新研究将解决文献中几个长期存在的问题，包括为什么女孩处于这种状态。 风险增加，哪些女孩可能面临最大的风险，以及哪些女孩未来 STB 的风险最高。