Social disconnection and cognitive vulnerability are proposed risk factors for suicidal outcomes in late life that reinforce one another in a vicious cycle. Prolonged social disconnection exacerbates pre-existing cognitive vulnerabilities, which in turn, perpetuate unhelpful patterns of behavior (i.e., poor lifestyle) and affect (i.e., emotional dysregulation), thereby increasing psychological distress and ultimately elevating suicide risk in late life. Yet, we do not understand how to accurately capture the multidimensional and dynamic aspects of social disconnection, nor the dynamic aspects of cognitive vulnerability among suicidal older adults. Here we propose an a) ecologically valid momentary assessment (EMA) of multi-dimensional aspects of social connection and b) mobile cognitive testing (MCT) of cognitive processes in one’s real world. EMA assessments provide a more accurate estimate of one’s social connections and cognitive functioning relative to retrospective questionnaires and traditional neuropsychological tests. A combined EMA and MCT protocol can capture the dynamic nature of social and cognitive risk factors for late-life suicide and show us 1) how contextual factors can influence variability in cognitive performance and 2) highlight whether MCT-based metrics of cognitive vulnerability may be modifiable targets for future suicide interventions.
This AFSP Young Investigator Grant application leverages an innovative mobile-based EMA and MCT combined approach to examine how dimensions of social disconnection and cognitive vulnerabilities sensitive to suicide risk (inhibitory control, cognitive flexibility, working memory) relate to suicidal ideation in the short-term (same week) and longer-term (3-month follow-up) among high-suicide risk depressed older adults. This study will also examine cognitive vulnerability as a mechanism linking social disconnection and suicidal ideation—to identify cognitive targets for future interventions.
We will enroll 60 depressed older adults (60+ years) at high-suicide-risk (>50% current suicidal ideation, >30% history of suicide attempt). We will examine short-term and longer-term associations between 1) dimensions of social disconnection and suicidal ideation, 2) MCT-based metrics of cognitive vulnerability (i.e., mean and variability) and suicidal ideation, and 3) cognitive vulnerability as a pathway linking social disconnection and suicidal ideation in depressed older adults at high-suicide-risk. We build on the complementary expertise of our research team: Drs. Szanto (mentor; late-life suicide, social connectedness), Gujral (PI; late-life depression, cognition in late-life suicide), Weinstein (consultant; social context and mobile cognitive testing in geriatric populations), Galfalvy (consultant; analysis of EMA data in high-suicide risk groups), and Moore (consultant; MCT). The PI is a junior investigator conducting her first independent study in late-life suicide. Dr. Gujral will benefit from the mentorship of Dr. Szanto, given her expertise in cognitive and social risk factors of late-life suicide and her experience in recruiting and engaging an ultra-high-suicide-risk group of depressed older adults in research. Dr. Szanto’s longitudinal study will make the recruitment of a high-suicide-risk older adult sample feasible. The results of this AFSP study will provide valuable novel pilot data to support an R01 application focused on better understanding proximal and dynamic cognitive, social, affective, and lifestyle risk factors for late-life suicide.
