Decision Processes in Late-Life Suicide

PROJECT SUMMARY / ABSTRACT This is a competing renewal studying risk factors of late-life suicidal behavior. Extending our prospective study, we propose to continue following our active cohort of high-suicide-risk older adults (n=150) and recruit 150 new participants (50 depressed non-attempters; and 100 depressed suicide attempters: 50 with early-onset and 50 with late-onset suicidal behavior), to continue to probe the complex, dynamic risk trajectories motivating suicidal thoughts and behavior (STB) in late-life depression. We plan to continue longitudinal clinical assessments of psychopathology, cognition, and STB. In depressed active and newly recruited participants, we will also add bidaily momentary assessments of daily functioning for 3 weeks at baseline and 6 months later: ecological momentary assessment (EMA) of suicidal ideation, affect, social connectedness, and sleep health; ecological momentary cognitive testing (EMCT); and actigraphy measures of sleep and circadian rhythmicity (RAR). We will further examine the clinical and cognitive trajectories and suicide risk profiles of older suicide attempters based on age of onset of suicidal behavior (early vs. late onset), as recent findings from the prospective study point to the existence of differential risk factors and trajectories. We aim to capture decision processes in daily life and understand the extent to which dynamic daily patterns, above and beyond clinical characteristics, can improve the precision of suicide risk prediction in real time (momentary suicidal ideation) and in the long-term (future STB over 2+ years). With statistician Galfalvy as MPI, we will have the expertise to model the multidimensional and complex risk architecture for suicide risk in late-life depression using cutting-edge statistical and machine learning approaches. These models will be able to predict who is at higher suicide risk, but also capture each individual’s daily life situations that predict momentary suicidal ideation. Expanding our longitudinal cohort of depressed older suicide attempters, we will also be able to probe whether age of onset of suicidal behavior (early-life vs. mid-to-late-life) may be a key contributor to heterogeneity in suicide risk profiles over time. Our team has established the feasibility of 1) recruiting and longitudinally following depressed older adults at high-suicide-risk and, 2) conducting a 3-week momentary assessment protocol with high adherence in this high-suicide risk group. For this renewal, we have built a highly interdisciplinary investigative team with the range of expertise and experience required to examine multidimensional momentary, behavioral, and clinical risk factors for late-life suicide. Our team has complementary expertise in: heterogeneity of late-life suicidal behavior (Szanto, Galfalvy, Szücs), neurocognitive processes late-life depression and suicidal behavior (Gujral, Szanto); statistical analysis of clinical and momentary longitudinal suicide risk factors (Galfalvy); ecological momentary assessments (EMA) of cognition (EMCT) and understanding effects of psychosocial context on daily life cognition (Weinstein, Moore, Gujral); and assessment of sleep health /circadian rhythms (Stahl, Franzen, Gujral).