Prospection in suicidal teens: Identifying a novel and malleable cognitive risk factor

Columbia University Teachers College, New York NY

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Abstract

PROJECT SUMMARY Suicidal ideation is an immensely distressing experience that often emerges in adolescence, recurs over time, and is difficult to treat. It is also one of the most potent risk factors for subsequent suicide attempt and death. Reducing suicidal ideation among adolescents may not only preempt the transition to suicidal behaviors but also alleviate distress during a time of critical growth. There are several barriers to advancing research and clinical care in this area. First, there have been limited studies of the prediction of near-term suicidal ideation. Second, previously studied psychological precipitants of suicidal ideation pertain to a desire for death when in fact suicidal ideation involves a deliberation between death and continued life. Third, most psychological precipitants have been captured using single time-point assessments that have limited ecological validity. In response to these barriers, a long-term goal of this line of research is to produce real-world strategies to mitigate suicidal thinking among adolescents. The immediate goal of this proposed R15 renewal is to examine in suicidal adolescents a candidate psychological precipitant of suicidal ideation: prospection specificity, or the degree of detail and spatiotemporal localization with which adolescents imagine future events. The central hypothesis is that poor prospection specificity will predict near-term increases in suicidal ideation. We will test how adolescents’ prospection specificity is associated with subsequent suicidal ideation and whether negative affect exacerbates this association. Using ecological momentary assessment (EMA), the proposed renewal will uncover the everyday experiences of future thinking among recently suicidal and nonsuicidal adolescents (n = 160) across 14 days. Specific Aims are to: (1) compare real-time experiences of prospection between recently suicidal and nonsuicidal adolescents; (2) test whether real-time prospection specificity predicts subsequent, near-term changes in suicidal ideation; and (3) test whether the interaction between negative affect and prospection specificity predicts near-term changes in suicidal ideation. This proposal is innovative because it: (a) features the rare prediction of near-term suicidal ideation (i.e., within minutes or hours); (b) targets a historically neglected component of life-and-death deliberations; (c) uses the most ecologically valid depiction of prospection specificity ever administered to suicidal adolescents; (d) posits the clinical significance of prospection specificity at an earlier point in life than previously assumed; and (e) integrates the study of prospection specificity with affective functioning. Findings from this project will improve our understanding of how prospection operates in real-time among suicidal adolescents, introduce a potential psychological precipitant of suicidal ideation, and broaden our understanding of affective contexts in which these near-term predictions occur. These significant knowledge gains will inform whether, when, and in which contexts we can intervene on this proximal precipitant of suicidal ideation outside of standard treatment settings.