Effectiveness of a Targeted Brief Intervention for Recent Suicide Attempt Survivors

美国的自杀率正在上升，超过100万美国人试图结束自己的生命。 年对企图自杀的人进行有效、简短、低成本的干预对于挽救生命和 实现国家预防自杀战略的目标。这个建议利用了一个时间- 敏感的研究机会，以测试自杀未遂短期干预计划的有效性 （ASSIP），一个手动3会话干预最近自杀企图幸存者，产生戏剧性的 有效性试验中的自杀企图减少-再尝试减少80%，住院平均减少72% 在24个月内，干预组与对照组相比。我们的研究现在将测试其 美国公共精神卫生保健系统的有效性，检查理论上的基础机制， 探索成本效益。ASSIP目前正由纽约州在零自杀倡议中实施 由SAMHSA资助。与NIMH的MH-17-031兴趣通知一致，我们的项目利用这个联邦 投资和强有力的国家伙伴关系，以进行有效性研究。我们的项目有三个目标： 目标1。有效性本研究的主要目的是确定ASSIP在减少 在美国的社区精神健康环境中自杀未遂。为了实现这一目标，我们将进行一项 随机对照试验，纳入400例精神病住院和急诊患者 在自杀未遂之后受试者将随机接受常规护理+ ASSIP（干预） 组）或仅常规护理组（对照组），并在基线、3、6、12和18个月时进行评估。 目标2.机制本研究的第二个目的是检查ASSIP的心理机制， 人际自杀理论所预言的。我们将对调解模型进行统计分析， 确定（a）ASSIP是否改善了对低归属感和成为他人负担的看法，以及（B） 是否通过这些改善来介导治疗对自杀再企图减少的影响。 目标3。成本效益。本研究的探索性目的是从一个 ASSIP提供者，通过提供ASSIP以补充常规护理而避免的每次自杀企图的增量成本 在自杀未遂之后我们将收集实施前的会计数据、人员时间日志和12- 急诊和住院精神科就诊的月病历报告。我们将把这些数据结合起来使用 与有效性的结果，以计算增量成本效益比（ICER）。这项时间紧迫的研究 将有效性研究纳入联邦政府资助的纽约州零自杀补助金， NIMH对此类应用的具体要求。如果假设得到支持，研究将提供证据， 一种简单，实用，新颖的治疗方法，可以减少现实世界健康环境中的自杀企图。 如果假设得到支持，该研究将提供证据证明一种简短，实用和新颖的治疗方法， 在现实世界的健康环境中自杀未遂。

Suicide rates are rising in the US and more than a million Americans try to take their own lives each year. Effective, brief, low-cost interventions for individuals who attempt suicide are essential to saving lives and achieving the goals of the National Strategy for Suicide Prevention. This proposal takes advantage of a time- sensitive research opportunity to test the effectiveness of the Attempted Suicide Short Intervention Program (ASSIP), a manualized 3-session intervention for recent suicide attempt survivors that produced dramatic reductions in suicide attempts in a efficacy trial–80% fewer reattempts and an average of 72% fewer hospital days over 24 months in the intervention group compared to controls. Our research will now test its effectiveness of in the US public mental health care system, examine theoretically grounded mechanisms, and explore cost-effectiveness. ASSIP is currently being implemented by New York State in a Zero Suicide initiative funded by SAMHSA. Consistent with NIMH Notice of Interest MH-17-031, our project leverages this federal investment and a strong state partnership to conduct effectiveness research. Our project has three aims: Aim 1. Effectiveness. The primary aim of this study is to determine the effectiveness of ASSIP in reducing suicide reattempts in a community mental health setting in the U.S. To accomplish this aim we will conduct a randomized controlled trial with 400 individuals referred from psychiatric inpatient and emergency services following a suicide attempt. Participants will be randomized to receive either usual care + ASSIP (intervention arm) or usual care only (control arm), and followed for assessments at baseline, 3, 6, 12, and 18 months. Aim 2. Mechanism. The secondary aim of this study to examine the psychological mechanisms of ASSIP as predicted by the Interpersonal Theory of Suicide. We will conduct statistical analyses of a mediation model to determine (a) whether ASSIP improves perceptions of low belonging and being a burden on others, and (b) whether the effect of treatment on reductions in suicide re-attempts is mediated by these improvements. Aim 3. Cost-Effectiveness. The exploratory aim of this study is to estimate, from the perspective of an ASSIP provider, the incremental cost per suicide attempt averted by delivering ASSIP to supplement usual care following a suicide attempt. We will gather pre-implementation accounting data, personnel time logs, and 12- month medical record reports of emergency and inpatient psychiatric visits. We will use these data together with effectiveness results to calculate the incremental cost-effectiveness ratio (ICER). This time-sensitive study builds effectiveness research into a federally-funded Zero Suicide grant to New York state, consistent with a specific request from NIMH for such applications. If hypotheses are supported, the study will provide evidence of a brief, practical, and novel therapy that reduces suicide reattempts in a real-world health setting. If hypotheses are supported, the study will provide evidence of a brief, practical, and novel therapy that reduces suicide reattempts in a real-world health setting.