Using Neuroimaging to Enhance Veteran Suicide Risk Detection and Prevention

Background: This application is for a five-year Career Development Award (CDA) to support my transition to becoming an independently funded VA clinical science and suicide prevention researcher. Career Plan: To successfully achieve my career goal of understanding why people die by suicide to enhance risk identification and prevent suicide among high-risk Veterans, I need further mentored training in two advanced clinical research methods, including neuroimaging and technology-based ecological momentary assessment (EMA), and biostatistics. My training objectives are to develop expertise in these three areas through formal coursework, seminars, clinical training, and mentorship from Kelvin Lim, MD (primary mentor; Minneapolis VA Health Care System, MVAHCS), Paul Thuras, PhD (MVAHCS), and Evan Kleiman, PhD (Rutgers University). Research Plan: This CDA examines brain regions associated with suicide capability among high-risk Veterans who are discharging from inpatient care. Suicide capability contributes to the transition from suicidal thinking to suicide attempts and distinguishes people who attempt suicide from those who think about it but do not act. As such, suicide capability is a valuable suicide prevention target. During inpatient care, Veterans will complete baseline assessments. After discharge, Veterans will complete suicide capability tasks while undergoing MRI scanning and daily EMA surveys for one month. Specific Aims: 1) Characterize the within-day associations of suicide capability and suicidal thoughts; 2) Compare activation in specific brain regions and suicide capability task responses when completing suicide capability tasks between depressed suicide attempters and depressed controls; and (3) Investigate the associations between brain activation during suicide capability tasks and self-reported suicide capability. Significance and Innovation: Suicide rates are especially high among Veterans during the transition from inpatient to outpatient care, pointing to the need for improved suicide risk detection and prevention strategies for Veterans after discharge. The proposed research investigates suicide capability, a promising suicide prevention target given its role in the transition from suicidal thinking to suicide attempts. Neuroimaging and technology-based EMA methods will be leveraged to advance our understanding of suicide capability and facilitate future proposals evaluating biological interventions targeting suicide capability that may impede the progression from suicidal thinking to suicide attempts. This work is responsive to calls by the VA and national/international organizations to optimize suicide prevention strategies for Veterans during high-risk transition periods.