PROJECT SUMMARY / ABSTRACT
Suicide rates are high in late adulthood, peaking in midlife among women and late life among men. Social
disconnection also peaks in late life and increases risks of suicide, persistent suicidality, and poor response to
psychosocial interventions. Our proposal responds to RFA-MH-22-135, outlining the critical need to identify the
mechanisms mediating the relationship between social disconnection and late-life suicidality and develop
efficacious interventions to target these mechanisms.
The proposed study leverages methodological and conceptual innovations, developed by our team, to
investigate target engagement of the Positive Valence System (PVS) during a novel social reward psychotherapy
for mid- and late-life suicidality. We designed Engage & Connect, a remotely delivered psychotherapy that
targets social disconnection by increasing engagement in rewarding social activities. Engage & Connect aims to
alter disturbances of the PVS that may underlie late-life suicidality. In this study, 128 adults aged 50-80 with
major depressive disorder and suicidal ideation will be randomized to 9 weeks of Engage & Connect or Symptom
Review and Psychoeducation (SRP) active control condition. We will measure PVS functions on brain and
behavioral levels, through resting state functional connectivity of the PVS and behavioral changes in social
reward responsivity using our novel validated STAR task (Social Task for Assessment of Reward). We will
employ a cutting-edge “precision imaging” approach to estimate the functional brain map of each individual and
track the longitudinal effects of treatment on PVS circuitry. Our rigorous methodological approach will allow us
to test, at the individual level, the brain-based and behavioral mechanisms underlying response to psychotherapy
that targets social disconnection. Identification of individual patients’ biological and behavioral profiles, linked
with treatment response, can guide future psychotherapy personalization and increase its efficacy and reach to
vulnerable older adults at risk of suicide.
