Real Time Assessment of Emotion Regulation and Suicidal Ideation among Individuals with First-Episode Psychosis

Individuals early in the course of psychotic disorders are at increased risk for suicide with approximately 20% to 40% reporting suicidal ideation and up to 10% attempting suicide during the first few year of illness. Unfortunately, very little is known about the mechanisms that lead to suicidal thoughts in this population. Emotion regulation- the use of strategies to modify the intensity, duration, frequency, and perceived quality of emotions- is a trans-theoretical mechanism included among numerous theories for suicide. Despite well-documented emotion regulation abnormalities among individuals with psychosis, very few studies have examined the relationship between emotion regulation and suicidal ideation in this population. The proposed study addresses this gap by using the most widely studied emotion regulation framework, the Extended Process Model, to examine emotion regulation as a mechanism for suicidal thoughts. According to this model, emotion regulation is a dynamic process that involves three stages: 1) the identification of whether to regulate an emotion, 2) the selection of an emotion regulation strategy, and 3) the implementation of the strategy. We will examine whether differences in these three stages (Aim 1) contribute to suicidal thoughts among individuals with first-episode psychosis (FEP). We hypothesize that individuals with FEP who have suicidal ideation (compared to those without suicidal ideation) will 1) demonstrate a lower threshold for regulating emotions (identification stage), 2) select greater maladaptive emotion regulation strategies (selection stage), and 3) will demonstrate reduced effectiveness in the implementation of emotion regulation strategies (implementation stage). We will also examine whether ineffective emotion regulation precedes the acute onset of suicidal thoughts (Aim 2). We will examine these hypotheses using Ecological Momentary Assessment (EMA), a novel assessment approach that is ideal for studying the dynamic nature of emotion regulation and suicidal ideation. We will recruit 62 individuals with FEP with and without suicidal ideation in the past month. Data collection will involve three stages: baseline laboratory assessment, 4 weeks of EMA, and a follow-up laboratory assessment. At baseline and follow-up, all participants will complete measures of suicidal ideation, lifetime suicide attempts, emotion regulation, depressive symptoms, and psychosis symptoms. All participants will also complete 4 weeks of EMA using a comprehensive battery that examines suicidal ideation, emotion regulation, positive and negative emotional states, and psychosis symptoms. This EMA approach will allow us to determine whether emotion regulation plays a mechanistic role in the acute onset of suicidal thoughts. Such work has the potential to advance our ability to optimally predict the onset suicidal thoughts and ultimately develop novel preventative interventions for this high-risk population. Future work in this proposed line of research would combine EMA with wearable technology to examine psychophysiological measures (e.g. heart rate) that can be used to examine the threshold for regulating emotions (identification stage) and the effectiveness of emotion regulation (implementation stage) as they relate to suicidal ideation. Finally, our systematic investigation of emotion regulation will also enhance future opportunities to link specific abnormalities to biological and neural processes that might contribute to suicidal thoughts and behaviors.