3 - (SYM 18) Applying EEG to Identify Risk for Suicide Attempts in Adolescents Following Acute Psychiatric Treatment

With increasing rates and the potential for lethal consequences, adolescent suicide attempts (SA) are a major public health concern. Patients with SA histories show alterations in reward valuation, such that they are more likely to select smaller immediate rewards over larger delayed rewards compared to those with no past SA, which is thought to manifest as a way to escape distressing situations, rather than waiting for future rewards while enduring emotional pain. Youth at risk for SA often present to acute treatment settings (e.g., partial hospital programs) and are at high risk for attempts following discharge. Integration of objective research measures in these settings may elucidate novel risk processes and prevention targets. I will present a study applying electroencephalogram (EEG) methods to assess reward valuation at the neural level. In study 1, we examined a reliable EEG measure of responsiveness to rewards delivered immediately (i.e., reward positivity [RewP]) in 58 clinically depressed adolescents. Adolescents with active SI (39.7%) or SA history (5.2%) showed an enhanced neural response to immediate rewards (b=0.54, SE=0.20, p< .01) and reported greater desire for new rewards compared to depressed adolescents without active SI/SA. Importantly, neural measures improved classification of suicidality beyond clinical and self-report measures. Based on these results, we developed an innovative EEG task to directly manipulate reward valuation as a function of delay. In this modified monetary incentive delay (MID) task, participants respond as quickly as possibly to a target following a cue indicating potential monetary rewards today or 6 months from now. Next, they receive monetary reward or loss feedback depending on performance. We are currently testing these methods in a longitudinal study of adolescents followed after discharge from acute psychiatric treatment for SI and/or SA to examine whether neural measures of reward valuation prospectively predict future SA in high-risk youth. In study 2, a pilot sample of 17 adolescents completed the modified MID task following discharge from partial or inpatient hospitalization for SI/SA. Reaction time (RT) was faster overall on immediate vs. delayed reward trials (p< .05, d=.53) with a trend for an enhanced RewP to wins vs. losses on immediate vs. delayed reward trials (d=.34). Notably, adolescents with histories of SA showed larger neural responses to immediate rewards than adolescents with only SI (p< .05, d=1.01). We will update results with a larger sample for the presentation.