Over the past 15 years, the rate of suicide deaths in children (8-12 years old) has almost doubled. Given this pressing public health concern, there is a critical need to identify predictors of suicide risk in children to facilitate the development of novel treatment approaches. Emergency departments (ED) often serve as a primary point of medical contact for many suicidal children across economic, racial, and ethnic spectra. The first 3 months post-discharge are vulnerable for suicides to occur, and thus, identifying proximal risk factors for suicidal thoughts and behaviors (STB) post-discharge may inform targeted treatment plans in children.
Chronic stress and poor sleep health are critical risk factors for STB. Chronic stress exposure dysregulates the hypothalamic-pituitary-adrenal (HPA) axis, thereby blunting cortisol levels. Measuring hair cortisol concentration (HCC) secretion levels is a non-invasive and reliable way to quantify the accumulation of chronic HPA axis activity. Therefore, measuring HCC at the ED may help determine chronic stress levels leading up to the current ED admission. Disrupted sleep health is also a risk factor for STB in youth. However, the temporal association between sleep health and STB in children is poorly understood. Wearables non-invasively measure sleep health over several weeks making it possible to examine the proximal association between sleep and STB in children. Both chronic stress and disrupted sleep health are associated with negative urgency, a facet of impulsivity that is characterized by rash actions during negative mood states. Although negative urgency is related to recent suicide attempts in adolescents, this association in children is not yet understood. Importantly, chronic stress is associated with increased daily negative urgency in adults. Relatedly, insufficient sleep reduces the ability to control impulsive behaviors in children. Collectively, both chronic stress and poor sleep health relate to negative urgency and STB among older individuals. A critical next step is to test whether chronic stress and poor sleep health potentiate the association between negative urgency and suicide events (i.e., suicide attempts, psychiatric hospitalizations, ED visits for suicidal concerns) among children. This may yield important information for developing targeted therapeutic interventions focused on enhancing adaptive strategies for children who exhibit HCC blunting and poor sleep health.
To address an issue of critical public health importance, this project will enroll children (N=60; ages 8-12-years-old) admitted to the New York-Presbyterian pediatric ED for suicide-related concerns (e.g., self-harm, suicide ideation, plans, attempts). At baseline, children and their parent will complete assessments including sociodemographic background, psychiatric symptoms, STB history, stress exposures, negative urgency, and sleep health patterns. Hair strands will be collected at the ED to measure past-3-month HCC. Wearable actigraphy will be administered to children at the ED, which will acquire sleep health information for 1-month post-ED discharge. During the 3-month post-ED discharge period, parents and children will complete weekly electronic surveys regarding negative urgency, sleep health, and STB. At a 3-month follow-up, children will be re-administered assessments. Collectively, this project directly addresses a public health priority by identifying factors that will improve the detection of suicide risk in children.
