Victor Sarah E, Christensen Kirsten, Johnson Sheri L, Van Allen Jason, Brick Leslie A
Department of Psychological Sciences, Texas Tech University, Lubbock, TX, United States.
Department of Psychology, University of California at Berkeley, Berkeley, CA, United States.
JMIR Res Protoc. 2022 Jun 30;11(6):e38582. doi: 10.2196/38582.
US suicide rates have risen steadily in the past decade, and suicide risk is especially high in the months after discharge from inpatient psychiatric treatment. However, suicide research has lagged in examining dynamic within-person processes that contribute to risk over time among individuals known to be at high risk of suicide. Almost no research has examined how affective, cognitive, and physiological processes change over minutes, hours, or days to confer risk of suicidal behavior in daily life.
This protocol describes a longitudinal study designed to examine real-world changes in risk of suicide across multiple assessment domains. Specifically, the study involves following adults known to be at high risk of suicide after discharge from inpatient psychiatric care using self-report, interview, actigraphy, and behavioral methods to identify proximal contributors to suicidal thoughts and behaviors. First, we hypothesize that negative affective experiences, which are featured in most major suicide theories, will comprise a latent factor indicative of psychache (emotional pain), which will predict increases in suicidal thinking over time. Second, we hypothesize that poor inhibitory control in the context of negative affective stimuli, as well as emotion-related impulsivity, will predict the transition from suicidal thinking to suicidal behavior over time. Third, we hypothesize that short sleep duration will precede within-person increases in suicidal ideation as well as increased odds of suicidal behavior among those reporting suicidal thoughts.
The desired sample size is 130 adults with past-week suicidal thoughts or behaviors who are receiving inpatient psychiatric treatment. Participants will complete a battery of measures while on the inpatient unit to assess negative affective experiences, emotion-related impulsivity, inhibitory control, typical sleep patterns, and relevant covariates. After discharge from inpatient care, participants will complete 4 weeks of signal-contingent ecological momentary assessment surveys, as well as mobile behavioral measures of inhibitory control, while wearing an actigraphy device that will gather objective data on sleep. Participants will complete interviews regarding suicidal thoughts and behaviors at 4 and 8 weeks after discharge.
The study was funded by the National Institutes of Health in November 2020. Recruitment began in April 2021. Data analysis will begin after completion of data collection.
This study will elucidate how affective, cognitive, and physiological risk factors contribute (or do not contribute) to within-person fluctuations in suicide risk in daily life, with important implications for extant theories of suicide. Of import, the examined risk factors are all modifiable; thus, the results will inform identification of key targets for just-in-time, flexible, personalized, digital interventions that can be used to decrease emotional distress and prevent suicide among those at highest risk.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/38582.
在过去十年中，美国的自杀率稳步上升，且在住院精神科治疗出院后的几个月里自杀风险尤其高。然而，自杀研究在考察导致已知自杀高风险个体随时间推移产生风险的动态个体内部过程方面一直滞后。几乎没有研究考察过情感、认知和生理过程如何在数分钟、数小时或数天内发生变化，从而在日常生活中带来自杀行为风险。
本方案描述了一项纵向研究，旨在考察多个评估领域中自杀风险的现实世界变化。具体而言，该研究包括对已知在住院精神科护理出院后有高自杀风险的成年人进行跟踪，使用自我报告、访谈、活动记录仪和行为方法来确定自杀想法和行为的近端促成因素。首先，我们假设，大多数主要自杀理论中都有的负面情感体验，将构成一个指示精神痛苦（情感疼痛）的潜在因素，它将预测自杀想法会随时间增加。其次，我们假设，在负面情感刺激背景下较差的抑制控制以及与情绪相关的冲动性，将预测随着时间推移从自杀想法向自杀行为的转变。第三，我们假设，睡眠时间短会先于个体自杀意念的增加以及在报告有自杀想法者中自杀行为几率的增加。
理想的样本量是130名在过去一周内有自杀想法或行为且正在接受住院精神科治疗的成年人。参与者在住院期间将完成一系列测量，以评估负面情感体验、与情绪相关的冲动性、抑制控制、典型睡眠模式和相关协变量。在住院护理出院后，参与者将完成4周的信号依存性生态瞬时评估调查，以及抑制控制的移动行为测量，同时佩戴一个活动记录仪，该记录仪将收集关于睡眠的客观数据。参与者将在出院后4周和8周完成关于自杀想法和行为的访谈。
该研究于2020年11月获得美国国立卫生研究院资助。招募工作于2021年4月开始。数据分析将在数据收集完成后开始。
本研究将阐明情感、认知和生理风险因素如何（或不如何）导致日常生活中个体自杀风险的波动，这对现有的自杀理论具有重要意义。重要的是，所考察的风险因素都是可改变的；因此，研究结果将为及时、灵活、个性化的数字干预确定关键目标提供信息，这些干预可用于减轻情绪困扰并预防最高风险人群的自杀行为。
国际注册报告识别码（IRRID）：DERR·1·10.2·196/38582 。
