Over the last 15 years, we have had great success in following a sample of formerly psychiatrically hospitalized adolescents (n=180) through adulthood to help us better understand the risk and course of suicidal thoughts and behavior. Using longitudinal data from this study, we have recently examined sensitization as a process that may contribute to recurrent suicidal behavior, the predictive validity of clinical characterisics of suicidal behavior, and differing developmental trajectories of suicide ideation and attempts from adolescence through adulthood. With this revised renewal application, we propose a behavioral model of the recurrence or maintenance of suicidal thoughts and behavior. Four cognitive and affective mechanisms are hypothesized to reflect underlying behavioral processes: (a) delay discounting (a decision-making bias characterized by greater focus on immediate rewards rather than delayed consequences, assessed with the Iowa Gambling Task), and (b) implicit affect (assessed with the Affect Misattribution Procedure), (c) eye blink startle reflex (a physiological indicant of defensive responding), and (d) postauricular reflex (a physiological indicant of approach or appetitive responding) in response to suicide-related stimuli. Using an approach consistent with the Research Domain Criteria (RDoC) initiative of NIH and cognitive and affective neuroscience, we propose to examine these four mechanisms in relation to severity of suicidal thoughts and behavior over time in this longitudinal sample. Th first specific aim of this grant is examine these four mechanisms in relation to severity of suicidl thoughts and behavior from adolescence through young adulthood (i.e., in relation to longitudinal data from 15 years of follow-up).
The second aim of this grant is to examine the stability of the mechanisms over time, and the degree to which these variables covary with severity of depression and substance use, as well as psychiatric disorders.
The third aim of the grant is to examine the utility of these mechanisms in predicting severity of subsequent suicide ideation and behavior over an additional three years of follow-up. Exploratory aims of this study are to explore (a) the degree to which these cognitive and affective mechanisms are associated with established risk factors for suicidal thoughts/behavior, and (b) the degree to which possible patterns of developmental mediation leading to suicidal ideation/attempts are associated with the hypothesized cognitive and affective mechanisms. For all Aims, we will explore gender and ethnicity effects and the possibility of gender and ethnicity moderation. This study also has clear translational implications for prediction of suicidal thoughts and behavior, and for intervention development for individuals with differing histories of suicidal thoughts and behavior.

Public Health Relevance

The understanding and prevention of suicidal behavior has been recognized as a public health priority in the US. Building upon the foundation of earlier repeated follow-up of this sample from adolescence through young adulthood, we will examine several understudied mechanisms (cognitive and affective correlates of behavioral processes) potentially related to patterns of suicidal thoughts and behavior over time. The results of this study will have clear implications for the development and focus of new behavioral interventions for reducing the risk of suicidal behavior.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Psychosocial Development, Risk and Prevention Study Section (PDRP)
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Garriock, Holly A
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Duke University
Schools of Medicine
United States
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Goldston, David B; Erkanli, Alaattin; Daniel, Stephanie S et al. (2016) Developmental Trajectories of Suicidal Thoughts and Behaviors From Adolescence Through Adulthood. J Am Acad Child Adolesc Psychiatry 55:400-407.e1
Goldston, David B; Daniel, Stephanie S; Erkanli, Alaattin et al. (2015) Suicide attempts in a longitudinal sample of adolescents followed through adulthood: Evidence of escalation. J Consult Clin Psychol 83:253-64
Sapyta, Jeffrey; Goldston, David B; Erkanli, Alaattin et al. (2012) Evaluating the predictive validity of suicidal intent and medical lethality in youth. J Consult Clin Psychol 80:222-31
Goldston, David B; Daniel, Stephanie Sergent; Erkanli, Alaattin et al. (2009) Psychiatric diagnoses as contemporaneous risk factors for suicide attempts among adolescents and young adults: developmental changes. J Consult Clin Psychol 77:281-90
Daniel, Stephanie S; Goldston, David B; Erkanli, Alaattin et al. (2009) Trait anger, anger expression, and suicide attempts among adolescents and young adults: a prospective study. J Clin Child Adolesc Psychol 38:661-71
Goldston, David B; Reboussin, Beth A; Daniel, Stephanie Sergent (2006) Predictors of suicide attempts: state and trait components. J Abnorm Psychol 115:842-9
Goldston, David B (2004) Conceptual issues in understanding the relationship between suicidal behavior and substance use during adolescence. Drug Alcohol Depend 76 Suppl:S79-91