Identifying Periods of High Risk and Predictors of Suicide for Youth in Public Child Serving Systems

摘要 自杀现在是10-24岁年轻人的第二大死因，在#年死亡人数更多。 这个年龄组比其他十个主要死因的所有年龄段的总和还要多。美国外科医生的愿景 将军和国家预防自杀行动联盟(行动联盟)是一个没有自杀的国家 自杀的悲剧性经历。为了追求这一愿景，行动联盟的研究优先工作组 (RPTF)发布了一项研究议程，旨在将自杀死亡和自杀企图减少20% 2025年。为了实现这一雄心勃勃的目标，RPTF建议战略性地针对以下目标进行干预 在指定的“边界环境”中自杀风险较高的人群亚群。公共资助中的青年 保健系统(例如，医疗补助、儿童福利、少年司法和行为健康)是一个特别重要的问题 年，与年轻人相比，自杀和精神疾病风险较高的大量和重要的“边缘人口” 普通民众。不幸的是，尽管在公共资助下有大量的弱势青年 计划，对这一人群的自杀率和预测因素知之甚少。这项研究项目 建议首次创建一个基于人口的综合数据库，将9年来的数据连接到 多家俄亥俄州儿童服务机构。这是一个独特的自杀预防资源，目前是任何 联邦数据系统。这项研究有可能为以下方面提供深入的前瞻性信息 动态的个人和背景因素之间的相互作用，可能会卓有成效地应用于 制定有针对性的自杀预防和干预计划。这项拟议研究的具体目标 有三个方面：1)量化俄亥俄州4个公共儿童服务系统内的自杀发生率； 2)确定公共资助部门青年自杀的高危时期；以及3)制定和 验证风险预测算法以估计该人群中的个体自杀风险。我们的中央 假设儿童福利和少年司法项目的进入和退出将与 自杀风险增加，精神卫生保健水平之间的重大过渡也会增加(例如，从 住院病人到门诊病人)。这项回溯性的纵向队列研究将使用220万名公共场合青年的数据 10-24岁的儿童服务系统，将从2010年到2018年进行跟踪。我们采用了一种新的多态 检验护理转变假说的统计建模方法(目标2)和依赖时间的COX 回归研究公共儿童服务系统中青少年自杀的预测因素(目标3)。这样做的结果 创新研究将确定高风险过渡期，并有助于更好地了解 在公共资助系统中的青年自杀。可行性得到了我们现有承诺的支持 国家合作伙伴提供实现我们目标所需的相关数据。

Abstract Suicide is now the second leading cause of death in youth aged 10-24 years, accounting for more deaths in this age group than all those for ten other leading causes of death combined. The vision of the U.S. Surgeon General and the National Action Alliance for Suicide Prevention (Action Alliance) is “a nation free from the tragic experience of suicide.” In pursuit of this vision, the Action Alliance's Research Prioritization Task Force (RPTF) released a research agenda aimed at reducing suicide deaths and suicide attempts 20 percent by 2025. To achieve this ambitious goal, the RPTF has recommended strategically targeting interventions at population subgroups at high risk for suicide in designated “boundaried settings”. Youth in publicly funded systems of care (e.g., Medicaid, child welfare, juvenile justice, and behavioral health) represent an especially large and important “boundaried population” at heightened risk of suicide and mental illness relative to youth in the general population. Unfortunately, despite the large numbers of vulnerable youth in publicly funded programs, little is known about the rates and predictors of suicide for this population. This research project proposes to create, for the first time, an integrated population-based database that links 9 years of data across multiple Ohio child-serving agencies. This is a unique suicide prevention resource currently unmatched by any federal data system. This research has the potential to provide in depth prospective information concerning interactions between dynamic individual and contextual factors that might be fruitfully applied to the development of targeted suicide prevention and intervention programs. Specific aims of this proposed research are three-fold: 1) to quantify the incidence of suicide across and within 4 public child-serving systems in Ohio; 2) to identify high risk periods for suicide among youth in publicly funded sectors; and 3) to develop and validate a risk prediction algorithm to estimate individual risk for suicide in this population. Our central hypothesis is that entry to and exits from child welfare and juvenile justice programs will be associated with increased risk for suicide as will major transitions across levels of mental health care (e.g., moving from inpatient to outpatient). This retrospective longitudinal cohort study will use data on 2.2 million youth in public child serving systems aged 10-24 years who will be followed from 2010 to 2018. We employ a novel multistate statistical modeling approach to test hypotheses about transitions of care (Aim 2) and time-dependent Cox regression to examine predictors of suicide for youth in public child serving systems (Aim 3). The results of this innovative study will identify high-risk transition periods and contribute to a better understanding of risk for suicide among youth in publicly funded systems. Feasibility is supported by an existing commitment from our state partners to provide the linked data necessary to accomplish our objectives.