Few NIMH-funded studies have examined contributors to short-term, within-person changes in suicidal ideation and odds of suicidal behavior. We propose to use multi-modal assessments (self-report, behavior, actigraphy) to capture changes in several RDoC domains relevant to suicide risk. In an ideation-to-action framework, we differentiate acute risk factors for suicidal thoughts from those that contribute to the transition from suicidal ideation to behavior. We will test our theoretical model using a 28-day intensive longitudinal design in a sample of suicidal adults leaving inpatient behavioral health care, a population at particularly high risk for suicide.
Aim 1 : Examine a set of transtheoretical risk factors as proximal predictors of within-person changes in suicidal thoughts. Using ecological momentary assessment, we will gather repeated measures of seven hypothesized ideation risk factors, as well as a dimensional measure of ideation, to model lagged relationships between affective risk factors and subsequent ideation. We expect that each affective risk factor will show a positive association with subsequent increases in suicidal ideation, and that these risk factors will co-occur in daily life such that they are best conceptualized as a single latent construct capturing emotional suffering (psychache).
Aim 2 : Test self-report and behavioral measures of inhibitory control as risk factors for suicidal behavior. We expect that participants who, at baseline, report greater emotion-related impulsivity, and who show impaired response inhibition in a behavioral task using negative valence stimuli, will have higher odds of suicide attempt over follow-up. Using a novel mobile adaptation of an inhibitory control task during the ecological momentary assessment period, we expect that within-person decrements in inhibitory control will precede within-person increases in likelihood of suicide attempt among individuals thinking of suicide.
Aim 3 : Evaluate objectively measured sleep duration as a proximal risk factor for both suicidal ideation and suicidal behavior. Using wrist-worn actigraphy devices, we will examine how short sleep duration, compared to participants? average sleep, relates to next-day ideation and attempts. We expect that short sleep duration will predict within-person increases in suicidal thoughts, as well as increased likelihood of suicide attempts, controlling for suicidal ideation. Finally, we will test an exploratory hypothesis, that the sleep-suicide attempt association is explained by sleep-related decreases in inhibitory control in the context of negative affect. Findings from this study will elucidate modifiable affective, cognitive, and physiological targets for just-in-time, mobile interventions to prevent suicide.

Public Health Relevance

The goal of the proposed work is to test affective, cognitive, and physiological processes as contributors to proximal risk of suicide in the daily lives of adults leaving inpatient psychiatric treatment. We will use ecological momentary assessment and actigraphy over a 28-day post-discharge follow-up to demonstrate how increases in negative affective experiences and decreases in total sleep time contribute to proximal within-person increases in suicidal ideation; further, we will show that decreased state (EMA) and trait (baseline) inhibitory control and acutely reduced total sleep time contribute to within-person transitions from suicidal thinking to suicidal behavior (e.g., suicide attempts). This work uses a novel approach that integrates RDOC constructs of negative valence, cognitive inhibition, and arousal (sleep) systems to elucidate proximal risk factors for suicide in a high-risk group of adults leaving intensive psychiatric care.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZMH1)
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Prabhakar, Janani
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Texas Tech University
Schools of Arts and Sciences
United States
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