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岁青年的第二大死亡原因， 这一年龄组的死亡人数超过了其他10个主要死亡原因的总和。美国外科医生的愿景 一般和全国预防自杀行动联盟（行动联盟）是“一个国家从自由的， 自杀的悲剧”。为了实现这一愿景，行动联盟的研究优先工作组 （RPTF）发布了一项研究议程，旨在减少自杀死亡和自杀企图20%， 2025.为了实现这一宏伟目标，区域工作队建议在战略上将干预措施的目标定为： 在指定的“边界环境”中自杀高风险的人口亚群。公共资助的青年 护理系统（例如，医疗补助，儿童福利，少年司法和行为健康）代表了一个特别 与青年相比，大量重要的“边界人口”自杀和精神疾病的风险更高， 普通民众。不幸的是，尽管有大量的弱势青年在公共资助的 然而，在这些计划中，人们对这一人群的自杀率和预测因素知之甚少。本研究项目 建议首次建立一个基于人口的综合数据库，将9年的数据连接起来， 多个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无与伦比的任何 联邦数据系统。这项研究有可能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，可能会卓有成效地适用于 制定有针对性的自杀预防和干预计划。本研究的具体目标 有三个方面：1）量化俄亥俄州4个公共儿童服务系统之间和内部的自杀发生率; 2)找出公营部门青少年自杀的高危期;及（三）制订及 验证风险预测算法，以估计该人群中自杀的个体风险。我们的中央 假设是，进入和退出儿童福利和少年司法计划将与 自杀风险增加，精神卫生保健水平的重大转变也会增加（例如，moving from 住院病人到门诊病人）。这项回顾性纵向队列研究将使用220万青少年的数据， 2010年至2018年将跟踪10-24岁儿童服务系统。我们采用了一种新颖的多状态 一种统计建模方法，用于检验关于护理转换（目标2）和时间依赖性考克斯的假设 回归研究预测自杀的青少年在公共儿童服务系统（目标3）。的结果 创新性研究将确定高风险过渡时期，并有助于更好地了解 公共资助系统中的青年自杀。可行性得到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.