Rationale
Suicide attempts among reproductive-age females peak perimenstrually, when the ovarian hormones are in their greatest flux. Across three crossover randomized trials in naturally cycling outpatients reporting suicidal ideation, perimenstrual estradiol stabilization prevented the acute symptom surge seen during baseline and placebo cycles.
Because patients differ in affective sensitivity to estradiol and progesterone, group-averaged analyses risk describing an average response that fits no individual patient. PINES is designed to recover person-level structure rather than average across it.
Design
Two cycles, densely sampled
Twice-daily symptom reporting with urinary hormone monitoring, across roughly two menstrual cycles.
Estradiol vs. placebo
Perimenstrual estradiol against placebo, with resting-state fMRI in each condition.
Six months
Follow-up contacts at two, four, and six months.
Aims
- Aim 1
Identify idiographic hormone-symptom networks associated with proximal suicide risk. Subgroup analyses are expected to include at least one group showing no hormonal effects.
- Aim 2
Identify person-specific and subgroup-level effects of estradiol stabilization on behavioral and neural networks that may explain the benefit of perimenstrual estradiol treatment.
Analytic approach
Analyses use group iterative multiple model estimation (GIMME), which recovers shared and person-specific network structure within the same model rather than assuming it in advance. It is applied to behavioral time series in Aim 1 and to resting-state connectivity in Aim 2.
This page covers what is in the public award abstract. If you want to talk about methods in more detail, or about collaborating, please get in touch.
Under construction Trial registration, protocol, and data-sharing details will be posted here.
Team
Study team
- Tory Eisenlohr-Moul, PhDPrincipal InvestigatorUniversity of Chicago
- Kathleen M. Gates, PhDCo-Investigator · dynamic network modelingUniversity of North Carolina at Chapel Hill
- Sarah Keedy, PhDCo-Investigator · neuroimagingUniversity of Chicago
- Pauline Maki, PhDCo-Investigator · cognition, estrogen, and the brainUniversity of Illinois Chicago
- Melissa Wagner-Schuman, MD, PhDStudy medical supervisor · reproductive psychiatryUniversity of Chicago
- Zehra Aftab, MDStudy physician · consultation-liaison and reproductive psychiatryUniversity of Chicago
Consultants
- Crystal Schiller, PhDAffect, estrogen, and the brainUniversity of North Carolina at Chapel Hill
- Jessica Peters, PhDClinical phenotyping, irritability, and the brainBrown University
- Natania Crane, PhDNeuroimaging of reward processes, substance useOhio State University