The principal investigators for the grant are Michael Frederick Armey, PhD, Research Psychologist, Butler Hospital, Associate Professor of Research, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Associate Director of the Consortium for Research Innovation in Suicide Prevention (CRISP), The Warren Alpert Medical School of Brown University, and Melanie Bozzay, MA, PhD, Postdoctoral Fellow, Clinical Psychology, The Warren Alpert Medical School of Brown University and the Providence VA Center for Neurorestoration and Neurotechnology.

“While we know who, in general, is at risk for suicide, such as people with mental illness, older adults, men, veterans, and others, these are huge groups, and even in people identified at risk, the chance of any one individual dying by suicide remains low.  So, we can use proximal predictors of risk - in the case if this study, technology to monitor sleep and affective, behavioral, and cognitive predictors of suicide risk - in the real world,” said Michael Frederick Armey, PhD, Research Psychologist, Butler Hospital, Associate Professor of Research, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Associate Director of the Consortium for Research Innovation in Suicide Prevention (CRISP), The Warren Alpert Medical School of Brown University.

“We follow patients after they're discharged from the hospital. They wear a sleep monitor watch and complete questionnaires on their phones to give us a clearer picture of each individual's risk profile. Although this technology and approach is fairly new, we published a paper back in 2018 that showed our approach is between two and three times better at linking emotional disturbance to elevations in suicidal ideation over a three week, post hospital discharge,” he added. 

According to Melanie Bozzay, MA, Postdoctoral Fellow (Clinical Psychology, PhD), The Warren Alpert Medical School of Brown University and the Providence VA Center for Neurorestoration and Neurotechnology, “Suicidal ideation and behavior are growing public health problems in the United States. Unfortunately, our current ability to predict suicide is only slightly above chance, which may be attributable to an overreliance on distal/cross-sectional risk factors that are weak proximal predictors of suicide risk. Modeling the complex process by which atypical sleep impacts daily functioning in conjunction with established proximal risk factors can aid in identifying contexts and time periods of greatest suicidal risk, modeled at the individual level.”

The proposed study builds upon Armey and Bozzay’s team’s extensive expertise in sleep/wake cycles, psychophysiology, deep phenotyping, and multi-method, multivariate, ecologically valid models of suicide vulnerability in high-risk psychiatric populations. During their upcoming research, they will examine how a holistic model of atypical sleep relates to known trait (baseline neurocognitive performance; e.g., greater impulsive tendencies, higher loss sensitivity, reduced ability to regulate emotions) and state (time-varying, occurring hours to days before SI/SB; e.g., momentary fluctuations in emotional reactivity, impulsivity; greater emotional lability; greater isolative tendencies), risk factors for suicide, and examine how these factors together proximally influence suicidal ideation and confer risk for future suicidal behavior.

For their study, Armey and Bozzay intend to recruit 200 psychiatric inpatients at high risk for suicide and conduct a baseline assessment of sleep/wake functioning and trait risk factors and use laboratory-based tasks coupled with psychophysiology (i.e., event-related potentials, heart rate variability, and electrodermal activity) to phenotype risk processes linked to arousal and cognitive systems. This baseline assessment will be followed by four weeks of EMA and digital phenotyping coupled with SAFTE-derived actigraphy to characterize key state risk factors.

“We will conduct follow-up assessments at 1-, 3-, and 6-months post hospital discharge to determine how our proximal model of risk prospectively predicts SI and SB. The proposed study aims to characterize proximal risk for suicide using intensive longitudinal methods and to identify “windows” of greatest risk for suicide, which may vary from person to person, that serve as markers for intensive intervention. Finally, we will leverage this extensive dataset to develop a model of the sleep-suicide relationship emphasizing the contribution of trait and state factors. The results of this study have the potential to greatly enhance our understanding of the phenomenology of suicide risk as it exists in the real world, with the potential to improve our ability to predict, prevent, and intervene using both traditional and technology-enhanced psychotherapies,” added Armey.

About Butler Hospital

Butler Hospital, a member of Care New England, is the only private, nonprofit psychiatric and substance abuse hospital serving adults, seniors and adolescents in Rhode Island and southeastern New England. Founded in 1844, it was the first hospital in Rhode Island and has earned a reputation as the leading provider of innovative psychiatric treatments in the region. The Major Affiliated Teaching Hospital for Psychiatry and Behavioral Health at The Warren Alpert Medical School of Brown University, Butler is recognized worldwide as a pioneer in conducting cutting-edge research. For more information, visit butler.org.