Dysregulation and Proximal Risk for Suicide

Presenter:

Stacia Friedman-Hill, Ph.D.
Division of Translational Research

Goal:

The goal of this initiative is to encourage research to understand the mechanisms by which dysregulation dynamically interacts with cognition and mood to confer imminent risk for suicide, and to identify modifiable targets for timely interventions during high risk periods.

Rationale:

A major goal of research on suicide is to improve our understanding of who is at most risk, why people transition from suicidal thoughts to action, and when to intervene (Prioritized Research Agenda for Suicide Prevention , Short-term Objective 1.C). Risk is a dynamic process and suicide attempts are often preceded by acute stressors. While many studies of suicide risk focus on emotion dysregulation, fewer studies have examined arousal and regulation and how these domains dynamically shape emotional and cognitive functions such as response to reward, frustrative non-reward, cognitive flexibility and control, or decision-making. Very few studies in the NIMH portfolio on suicide risk have focused on proximal risk.

This initiative would require researchers to explicitly explore how interactions between at least one construct in the Research Domain Criteria (RDoC) domain of “Arousal and Regulation” and one or more constructs in other RDoC domains are linked to imminent risk for suicide attempts. Studies focused solely on static suicidal traits, past behavior, or distal risk would not be considered responsive to this initiative, nor would studies that are solely focused on a single RDoC domain.

To be consistent with the RDoC Framework, projects would be required to recruit a transdiagnostic cohort and integrate at least two levels of analysis (e.g., behavior/cognition, neural circuits, genetics, molecular and cellular processes). Because the primary focus of this initiative is to reveal key mechanisms that determine imminent/proximal risk, approaches that harness technologies such as smart phones, wearable devices, and actigraphy would be encouraged. In this way, researchers could assess behavior, physiological state, and thoughts with fine temporal resolution (e.g., hours or days) in naturalistic settings. Computational approaches that quantify and predict risk state would also be encouraged.

This initiative would encourage research applications in the following areas:

• Sleep-related modulation of cognitive and/or emotional domains and how this may lead to suicidal ideation and behaviors.
• Disordered eating or substance use, and dynamic effects on other RDoC functional domains and suicidal ideation and behaviors.
• Contextually inappropriate reactivity to external and internal stimuli; how this modulates affective processing, cognition, and decision-making, and how this may lead to rapid increases in suicidal ideation or risk for suicidal behavior.
• Dysregulation following childbirth and its relation to mood, motivation, and cognition as well as risk for suicide ideation and attempt.
• Changes in arousal and regulation in response to behavioral, pharmacological, or neuromodulatory interventions and consequent effects on domains such as decision-making, risk-taking, perspective-taking, etc. and risk for suicide behaviors.