Suicide is the second leading cause of death for adolescents and young adults, with rates of suicide deaths rising in the past two decades. Research examining risk for suicide has focused largely on long-term risk factors, with limited empirical investigations of short-term predictors of suicide in adolescents during periods of highest risk. To develop effective interventions to prevent suicidal behaviors during these elevated risk periods, it is crucial to understand the regulatory mechanisms that may intensify risk or enhance resilience. Risk for suicide is a dynamic, state-sensitive process, often characterized as a relatively brief period of dysregulation. Thus, the ability to flexibly regulate emotional and biological responses to stressors is a critical process to examine in adolescents vulnerable to suicide. The proposed study seeks to address an important gap in current research by examining stress responses and emotion regulation flexibility at multiple levels of analysis to determine whether these processes are predictive of short-term suicide risk during the transition out of intensive hospital services. The study will include a sample of adolescents (N=90) with a past 30-day history of suicidal ideation and/or events that are currently receiving treatment in the Bradley Hospital adolescent partial hospital program. Participants will complete an initial assessment followed by a 2-week EMA protocol and a 3- month follow up assessment. The goals for the proposed project include: (1) characterizing emotion regulation flexibility in the context of interpersonal stress utilizing self-report, laboratory, and ecologically valid assessments; (2) examine associated physiological responses to affective cues and stressors; and (3) prospectively examine the relationship between regulatory responses and suicidal thoughts and behaviors. The proposed training plan closely aligns with the research goals of this project, and includes: (1) cultivating expertise in translational clinical research in adolescents at high-risk for suicidality; (2) immersive training in EMA data acquisition and intensive longitudinal data analysis; (3) gaining skills in utilizing psychophysiological methodology; and (4) professional development, including dissemination of research, fostering research collaborations, and further training in grant writing. The mentorship team has expertise in translational research in adolescent suicidality (Drs. Richard Liu and Brandon Gaudiano), EMA data collection during transition periods (Dr. Brandon Gaudiano), multi-level modeling for intensive longitudinal data (Drs. Leslie Brick and Richard Jones), and psychophysiological methods (Dr. Stephen Sheinkopf). This application has important clinical implications, as findings from this study may identify critical variables to monitor and target during high-risk periods. Thus, the proposed study has the potential to inform future research studies testing regulatory flexibility as a target mechanism for interventions for adolescents vulnerable to suicide.
This application aims to examine the role of flexible emotion regulation in the context of interpersonal stress at the behavioural and physiological level as a proximal indicator of risk for suicidal ideation and behavior in a high-risk adolescent sample. This proposal has both scientific and clinical significance because there are few studies clarifying the contribution of regulatory processes as they contribute to short-term risk for adolescent suicide. This research has the potential to identify factors that inform when adolescents are at greatest risk for suicidal outcomes in periods of transition and to identify targets for intervention during these periods.
