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.

项目摘要/摘要 自杀是美国10-34岁的死亡（仅次于事故）的第二大死亡原因， 是死亡率与精神疾病最密切相关的原因。从大约12岁开始，率 自杀的思想和行为（STB）急剧增加，尤其是在经历STB的女孩中 以男孩的速度是两倍。这些对青少年和女孩的明显增加已得到充分记录 数十年来，几乎在世界各地的每个国家/文化中都可以看到，但是，没有农场的理解 为什么它们存在。此外，关于何时最高的风险知之甚少。拟议的研究扩展了我们的 团队的先前工作，由两个先前的R01奖项资助，研究青少年女孩的压力反应是潜在的 STB轨迹的预测因素，以及K99/R00奖励，揭示了整个复制激素的变化 月经周期产生了高STB风险的特定周期（尤其是在月经期间） 在成年妇女中。具体而言，我们假设女孩将报告STB的较高的发生和严重性 在月经周期的天数，在其他周期阶段（散发性，排卵，中间体）的天数， 这些增加将是通过每天的负面影响和压力反应性的每日变化来介导的 月经阶段，并且具有更高周期性马龙灵敏度的女孩的长期风险更大， 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 在临床期间至少一年的12-17岁的临床推荐的女孩中，有200名。设计开始 每日调查有70天（两个周期），以评估负面影响和STB。此外，女孩还将完成两个 平衡的实验室就诊（处于高风险的围周期和低风险中炎阶段），在此期间 将评估其情感和身体（自主，皮质醇，基因组）对标准化的反应 实验室压力源。接下来，女孩将每周完全调查测量周期阶段，人际压力， 负面影响，并在一年的随访中进行STB。密集的两个月基线阶段使我们能够 检查月经周期如何塑造STB的日常情感和身体风险，并让我们诊断 每个女孩的敏感性程度。这些基线在马酮敏感性方面的个体差异可以 在评估的随访年中，被检查为STB的预测因子，尤其是在 社会压力提高。这种强大的设计将阐明每日STB的周期性变化（AIM 1）是否是 由情感和物理STB风险因素（例如负面影响）介导（AIM 2A；通过每日测量 调查）和社会压力反应性（AIM 2B；通过基于实验室的行为，生理和分子测量 生物标志物阿萨斯），同时也承认同时的两个个体差异 敏感性（即，并非所有女孩都会有严重的周期性情绪变化）和时间变化的人际压力（AIM 3）。这项创新的研究将解决文献中的几个长期存在的问题，包括为什么女孩在 风险增加，当女孩可能面临最大的风险，哪些女孩对将来的STB处于最高风险。