Suicide is the third leading cause of death among youth. Although considerable progress has been made in recent decades in identifying risk factors for suicidal behaviors, improvements in clinical intervention programs have been comparatively modest. These modest gains in clinical effectiveness reflect, in part, the fact that, although we know many of the risk factors for suicidal behaviors, we know little about how they confer heightened risk. Indeed, a history of self-injurious behavior (i.e., suicide attempts and non-suicidal self-injury [NSSI]) has been consistently found to be the strongest predictor of future suicide attempts. Yet, studies on the pathways and processes explaining the link between past and future suicidal behaviors have been lacking. Although both life stressors and impulsivity have been widely studied in relation to suicidal behaviors, and feature prominently in several theoretical models of suicidal behaviors, no studies have examined how they interrelate to predict future suicidal behaviors. This New Investigator application will address these critical gaps in current knowledge by integrating and extending findings from the separate lines of research on these risk factors for suicidal behavior. Specifically, it will examine how life stressors, different neurocognitive/neurobehavioral dimensions of impulsivity (encompassing two RDoC constructs, reward valuation and response selection, inhibition or suppression), and loss-related experiences, consistent with the RDoC construct of loss, may explain how past suicide attempts increase risk for future recurrences in a multivalve longitudinal study with a sample of 150 adolescent inpatients. Adolescents 14-16 years old will complete a state-of-the-art life stress interview and a multi-method and multi-dimensional assessment of impulsivity at the time of an inpatient psychiatric admission, and at 3-months, 6-months, 12-months, and 18- months' post-hospital discharge. The central hypothesis is that adolescents with a history of suicide attempts will (a) experience greater dependent stressors (i.e., those that are influenced by their own behaviors), and (b) this increased rate of dependent stressors, in turn, increases their risk for future suicide attempts. We also hypothesize that behavioral impulsivity will similarly predict future suicide attempts by generating greater dependent stressors. We will also examine whether NSSI predicts dependent stressors, which in turn predicts future suicide attempts. Findings from this study have the potential to advance clinical intervention strategies. The types of stressors found to be most relevant to suicide risk may speak to the promise of different clinical approaches (e.g., behavioral modification in the case of dependent stressors and coping skills for independent stressors). The

Public Health Relevance

of this application is evident as it addresses Healthy People 2020 Objective MHMD HP 2020- 2: 'Reduce suicide attempts by adolescents'. This application is also consistent with NIMH's Strategic Plan, which highlights the need for research on biomarkers and behavioral indicators related to psychopathology, and for research based on dimensions of observable behavior and neurobehavioral methodologies. PUBLIC HEALTH RELEVANCE: The purpose of this application is to examine how stressful life events and impulsivity may explain why past self-injurious behavior (i.e., suicide attempts and non-suicidal self-injury [NSSI]) is so strongly linked with future suicidal risk in adolescents The aims of this application are clinically significant because very little is currently known abou why adolescents who previously attempted suicide are at much greater risk for attempting again in the future, and current suicide prevention strategies are only modestly effective.

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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Emma Pendleton Bradley Hospital
East Providence
United States
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Walsh, Rachel F L; Sheehan, Ana E; Liu, Richard T (2018) Prospective prediction of first lifetime onset of suicidal ideation in a national study of substance users. J Psychiatr Res 107:28-33
Sheehan, Ana E; Walsh, Rachel F L; Liu, Richard T (2018) Racial and ethnic differences in mental health service utilization in suicidal adults: A nationally representative study. J Psychiatr Res 107:114-119
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Liu, Richard T; Trout, Zoë M; Hernandez, Evelyn M et al. (2017) A behavioral and cognitive neuroscience perspective on impulsivity, suicide, and non-suicidal self-injury: Meta-analysis and recommendations for future research. Neurosci Biobehav Rev 83:440-450

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