Social Threat, Adolescent Relationships, and Suicidality Study

There is no assignment to conditions. All participants will receive the same intervention, which is the completion of an experimental task in which participants are asked to remember the identities of actors displaying happy, sad, angry, and neutral expressions and tested on their memory. The study is designed to evaluate the effect of sustained neurocognitive responsivity to social threat on the participants' social connectedness and suicidality.

This study includes 1) a baseline clinical interview, 2) a laboratory-based EEG assessment (which includes the experimental task described above), 3) smartphone surveys in conjunction with passive ambulatory assessment, and 4) 3- and 6-month follow-up assessments of STBs.

Specifically, after phone screening, female adolescents (n=100, ages 12-17) will complete diagnostic interviews and symptom measures to confirm eligibility. Adolescents' current and lifetime STBs, including the presence, frequency, severity, and age-of-onset of suicidal ideation, plans, behaviors, and attempts will be assessed and differentiated from non-suicidal self-injurious thoughts and behaviors using the Self-Injurious Thoughts and Behaviors Interview.

Eligible participants will be invited for a laboratory visit during which they will complete the ERP Decoding Working Memory task while EEG is recorded. During each trial of the task, a face (angry, sad, happy, neutral) is randomly presented in the center of the screen. Participants are asked to remember the identity of the actor and will be tested on their memory of the identity after a delay. Specifically, participants will be asked to identify the actor from a group of four actors displaying the same emotion.

Following the laboratory visit, adolescents will complete 30-days of smartphone surveys (i.e., ecological momentary assessments [EMA]; 3 samples/day) assessing social experiences, social connectedness, and STBs. Following standard procedures, they will be randomly sampled within three blocks of time (morning, after school, evening) for a total of 90 surveys. Youth can "snooze" each prompt for up to one hour. The after-school prompt allows youth to report on experiences and thoughts they had during the school day. Once a week during the 30-day EMA protocol, participants will complete questions assessing STBs currently and during the previous week, using items adapted for EMA from the Columbia-Suicide Severity Rating Scale. During these weekly assessments, participants will indicate any STBs in the last week (i.e., since the last assessment). Finally, participants' time-stamped text, iMessage, and WhatsApp messaging logs will be downloaded at the end of the 30-day period using the software, iMazing, which creates an encrypted backup of these data.

Finally, STB assessments will be repeated at the 3- and 6-month follow-up assessments.

Certain information is withheld to protect the scientific integrity of the study design.

Inclusion criteria

• Between ages 12-17
• Reported recurrent suicidal thoughts and behaviors and/or non-suicidal self-injury within the past year.
• Medically and neurologically healthy, including no evidence of intellectual disability or serious cognitive impairment that would interfere with task performance
• Assigned female at birth
• Willing and able to give informed assent
• Own an iPhone

Exclusion criteria

• Unable to read or speak English or cognitive impairment preventing ability to complete assessments
• Lifetime presence of a neurological or serious medical condition
• Lifetime presence of a DSM-5 Autistic Spectrum Disorder
• Current DSM-5 Psychotic Disorder or severe Substance Use Disorder
• Uncorrected visual disturbance (<20/40 Snellen visual acuity)
• Presence of head injury or congenital neurological anomalies (based on parent report).