Project Summary/Abstract
Rates of suicidal thoughts and behaviors (STB) among young adults have reached a crisis level, especially for
those in the LGBTQ (i.e., lesbian, gay, bisexual, queer, questioning and/or transgender) population, who face
social stigma in addition to the typical developmental challenges. Although we know the general risk factors for
suicide, those have limited utility in predicting how, when, and in whom suicide occurs. It is critically
important to consider the role of social context because STB often occurs in response to a recent social threat
event such as rejection and could be more likely in those who have altered sensitivity of neural social circuitry.
The proposed R01 study in response to RFA MH-20-327 builds on social models such as Minority Stress
Theory and the Interpersonal Theory of Suicide and examines social risk factors of STB from distal to proximal
levels. The overarching goal is to predict change in STB, including cumulative intensity of STB and transition
from suicidal thoughts to behaviors, on a time scale from hours to days to months. We propose that in LGBTQ
young adults, STB occurs through social processing and regulation of socially generated negative affect (e.g.,
shame). Specifically, we examine the distal vulnerability factors of sensitivity in social brain circuitry and
negative urgency, or the tendency toward impulsive behavior in the face of painful negative affect, and the
proximal, time-varying factors of sleep dysregulation and social experiences (e.g., rejection). The study will test
the association of these distal and proximal factors with STB; differences in these factors between LGBTQ
young adults with vs. without STB; the interplay of distal and proximal factors; and the role of LGBTQ-related
characteristics (e.g., victimization, outness) in STB.
The study will include 130 participants age 18-30, all of whom identify as LGBTQ and 2/3 of whom have
recurrent suicidal ideation and lifetime history of suicidal behavior. Participants will complete a detailed
interview of STB, an fMRI scan using social threat paradigms, a 3-month protocol of actigraphy and
smartphone-based assessment, and a follow-up interview at 6 months. Smartphone data will include ecological
momentary assessment of social threat experiences and STB, as well as passively collected sensor data (e.g.,
social media app use, texting activity). Traditional and machine learning quantitative techniques will be
applied to determine contributions of distal and proximal factors to STB (e.g., occurrence of suicidal behavior),
individual differences in risk factors, and contributions of neural, sleep, social, clinical, and demographic
factors to STB. The study will elucidate the role of modifiable risk factors in STB and have relevance to clinical
neuroscience, suicidology, and prevention efforts.