Neural Mechanisms and Predictors of an Ultra-Brief Suicide Prevention Strategy

超简短自杀预防策略的神经机制和预测因子

基本信息

批准号：
10605345
负责人：
Stephanie Gorka
金额：
$ 64.22万
依托单位：
OHIO STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-05-01 至 2026-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10605345
关键词：
Accident and Emergency department Acute Address Adopted Adult Affective Aftercare American Award Behavior Behavioral inhibition Blinking Brain Cause of Death Cessation of life Chemosensitization Clinical Clinical Trials Design Cognitive Coping Behavior Data Development Distal Ecological momentary assessment Emotional Emotions Feeling suicidal Functional Magnetic Resonance Imaging Funding Mechanisms Goals Health Hour Individual Inpatients Intervention Joints Knowledge Mediating Medical Mission National Institute of Mental Health Neurobiology Neurophysiology - biologic function Neurosciences Outcome Outpatients Patient Self-Report Patients Prevalence Prevention Research Prevention strategy Primary Care Psychophysiology Public Health Randomized Recommendation Recording of previous events Recovery Research Risk Risk Management Series Services Signal Transduction Soldier Source Strategic Planning Suicide Suicide prevention Surveys System Technology Assessment Testing Time United States Volunteer Group Work brain based brain pathway career clinical decision-making cognitive reappraisal cohort comparison control data integration emotion regulation follow-up health care settings high risk high risk population improved indexing innovation longitudinal design multimodality neural neural circuit neural network neuromechanism post intervention preventive intervention prognostic indicator programs reducing suicide response stress reactivity stress reduction success successful intervention suicidal suicidal behavior suicidal risk suicide model suicide rate support network translational research program treatment planning

项目摘要

Close to 45,000 Americans die from suicide each year and rates have been steadily rising for the last two decades. There is an urgent need for better access to effective suicide prevention strategies that are highly transportable across medical settings. Data from the current team indicates that a single session of crisis response planning (CRP) reduces suicide behavior by 76%; however, it is unknown how CRP works, and for whom, curtailing strategy optimization and widespread implementation. Clinicians speculate that CRP works by strengthening emotion regulation capabilities and reducing stress reactivity; however, this hypothesis has never been tested and no prior study has identified neural mechanisms and predictors of changes in suicide risk following intervention. Related, there are no objective brain-based markers of ‘reduced’ suicide risk to inform clinical decision making and guide high-risk patients to needed services. To address these gaps and ultimately improve suicide prevention efforts we seek to identify brain-based mechanisms and predictors of changes in suicidality following a single session of CRP in a cohort of adults with active suicidal intent. We will take an innovative and comprehensive approach by probing stress reactivity and emotion regulation neural circuits in the context of a clinical trials design. Specifically, we will combine sources of information and simultaneously collect assessments of neural function, psychophysiology (i.e., startle eyeblink potentiation), behavior and self-report during functional magnetic resonance imaging (fMRI) before (Time 1) and after (Time 2) randomization to a single, one-hour session of CRP or standard suicide risk management (control). A small group of volunteers with no history of suicide ideation or intent will be included for comparison. Using ecological momentary assessment (EMA) technology, acute changes in suicidality following intervention will be assessed twice daily for the first week. Monthly online clinical surveys will also be administered, and at 6-months post- intervention, the entire multimodal assessment battery will be re-administered (Time 3). This innovative, multilayered, longitudinal design will allow for a well-controlled test of how a single session of CRP acutely changes suicide risk (Aim 1). The study will also address whether the acute effects of CRP are sustained over time and how neural function influences long-term changes in suicidality (Aim 2). Lastly, we will conduct sophisticated analyses to integrate data across ‘units of analysis’ and functional domains to test whether there are reliable prognostic indicators of CRP intervention success (Aim 3). Findings from this study will provide critical new knowledge regarding how an ultra-brief session of CRP works and for whom, while uncovering a mechanistic signal of reduced suicide risk. In addition, consistent with the mission of the NIMH BRAINS program, the award will facilitate the launch of the PI’s innovative translational program of research and pave the way for a series of large-scale studies aimed at identifying neurobiological targets for resolving suicide risk and testing whether interventions with effective target engagement can enhance suicide prevention outcomes.

每年有近 45,000 名美国人死于自杀，并且过去两年自杀率一直在稳步上升几十年来，迫切需要更好地获得有效的自杀预防策略。当前团队的数据表明，一次危机就可以转移。反应计划 (CRP) 可减少 76% 的自杀行为；然而，CRP 的作用原理尚不清楚；临床医生推测 CRP 的作用是通过限制策略优化和广泛实施来实现的。增强情绪调节能力并减少应激反应；然而，这一假设从未出现过。之前没有研究确定自杀风险变化的神经机制和预测因素相关的干预后，没有客观的基于大脑的“降低”自杀风险的标记来告知。临床决策并指导高风险患者获得所需的服务，并最终解决这些差距。改善自杀预防工作，我们寻求确定基于大脑的机制和自杀变化的预测因素我们将对一组有主动自杀倾向的成年人进行一次 CRP 治疗后的自杀倾向。通过探索应激反应和情绪调节神经回路的创新和综合方法具体来说，我们将结合信息来源并同时进行。收集神经功能、心理生理学（即惊恐眨眼增强）、行为的评估以及功能磁共振成像 (fMRI) 之前（时间 1）和之后（时间 2）期间的自我报告随机化为单次、一小时的 CRP 或标准自杀风险管理（对照）。没有自杀意念或意图历史的志愿者组将被纳入使用生态学进行比较。瞬时评估（EMA）技术，将评估干预后自杀倾向的急剧变化第一周每天两次，并在 6 个月后进行每月在线临床调查。干预后，整个多模式评估电池将被重新管理（时间 3）。多层纵向设计将允许对单次 CRP 的急性发作情况进行良好控制的测试该研究还将探讨 CRP 的急性影响是否持续存在。时间以及神经功能如何影响自杀倾向的长期变化（目标 2）。复杂的分析，跨“分析单元”和功能域集成数据，以测试是否存在是 CRP 干预成功的可靠预后指标（目标 3）。关于 CRP 超简短会议如何运作以及为谁服务的重要新知识，同时揭示了此外，与 NIMH BRAINS 计划的使命一致，该奖项将促进 PI 创新转化研究计划的启动，并为一系列旨在确定解决自杀风险和测试的神经生物学目标的大规模研究具有有效目标参与的干预措施是否可以提高自杀预防效果。