Neurocognitive responses to social threat: Links to day-to-day connectedness and suicidality in adolescent girls - ABSTRACT In the United States, suicide is the second leading cause of death among those aged 12-17 and rates of suicide are rising, particularly among teen girls. Critically, rates of non-fatal suicidal thoughts and behaviors (STB) among girls are even higher. Conceptually and empirically, social processes and neural responsivity to social threat have been linked to STB among youth. Factors related to social connectedness form the foundation of theoretical models of STB. Yet, the mechanism by which heightened social threat responsivity confers risk for STB in girls remains unclear. This K23 tests a model in which sustained neurocognitive responsivity to socially threatening experiences (SNRthreat) increases STB in girls by decreasing their social connectedness. I propose that girls' tendency to dwell on social threat disrupts their processing of positive socio-affective cues that promote connectedness. This K23 focuses on two forms of SNRthreat: 1) enhanced representation of social threat information in working memory and 2) perseverative thought about socially threatening experiences. A neural index of SNRthreat will be obtained in the laboratory. Cognitive and behavioral indices will be obtained through ambulatory assessment in daily life. Specifically, multivariate electroencephalogram (EEG) decoding will be used to assess enhanced neural representation of social threat information in working memory, signaling sustained internal attention to such information. Ecological momentary assessment (EMA) will be used to assess perseverative thought about social threat in daily life, and passive ambulatory assessment will be used to index repetitive texting about social threat. Social connectedness will also be assessed via EMA. STB, the primary outcome, will be assessed via clinical interview at baseline, weekly via EMA, and with questionnaires at three and six months. First, I will characterize the relation between the laboratory-based neural index and real-world cognitive and behavioral indices of SNRthreat (Aim 1). Next, I will examine if the neural index predicts girls' subsequent day-to-day social connectedness and longer-term differences in STB (Aim 2). Third, I will examine if the real-world cognitive and behavioral indices predict proximal changes in girls' connectedness and STB, and longer-term differences in STB (Aim 3). Participants will be a risk-enriched sample of 100 youth assigned female at birth (aged 12-17). Mentor-directed training from leading experts will facilitate future investigative independence and the development of skills in four new areas: 1) EMA, 2) passive ambulatory assessment, 3) natural language processing, and 4) developmental neuroscience. Determining how SNRthreat is linked to social (dis)connectedness could yield novel insights in the neurodevelopment of socio-affective processes that contribute to STB in girls. Multi-modal research that bridges laboratory-based neural indices and real-world responses is essential to developing targeted prevention and intervention efforts. These efforts could include ecologically valid just-in-time interventions and those aimed at reducing SNRthreat to enhance girls' ability to process cues that promote connectedness (e.g., a smile), in turn, reducing STB.
