Collaborative Hub to Reduce the Burden of Suicide among Urban American Indian and Alaska Native Youth

总体项目摘要 自杀是美国印第安人和阿拉斯加原住民的第二大死亡原因 (AI/AN）年龄在10-34岁之间，比白色同龄人高出6倍。土著青年 也承受着不成比例的自杀风险因素负担，包括精神健康障碍， 创伤性生活事件和药物滥用这些发现主要来自农村的研究， 预订设置。然而，我们知道，我们城市中的“隐形部落”面临着巨大的挑战， 这是因为缺乏与传统家庭和文化环境的联系。这些 这些挑战导致城市AI/AN青年和年轻成年人（YYAs）的风险显著增加 与非AI/AN的自杀未遂者相比（21%对7%），以及 抑郁症，药物滥用，帮派活动，青少年怀孕和虐待。但需要深思熟虑， 在城市AI/AN YYYAs中进行自杀预防的实用研究尚未得到 回答到现在。 我们对RFA-MH-17-350的回应旨在建立协作中心，以减少 AI/AN YYYAs中的自杀负担，承诺纠正城市和城市之间的不平衡， 自杀预防研究的农村重点。中心研究，“城市自杀预防” 土著儿童和青年（SPUNKY），”建立在筛选，短暂干预和转介， 通过初级保健环境进行的SBIRT治疗，以检测和管理自杀风险。 这种方法是多层次的，既针对医疗保健系统，也针对个人， 筛选现有的移动的电话技术，以提高弹性，并利用 社会联系的保护性好处。 该协作中心将：1）评估现有的SBIRT计划，以确定和解决因素 影响实施和预防自杀的AI/AN YA患者服务的 西雅图印第安人健康委员会和全国最大的第一民族社区健康来源 城市印度卫生组织; 2）进行随机对照试验，比较 通过发送关怀短信来提高这些SBIRT计划的有效性， 自杀意念，企图和住院治疗，并增加参与，社会 连通性和弹性，3）对SBIRT进行系统的经济评估， 它的改进，以确定其对医疗资源使用的相对影响， 生活质量我们的长期目标是传播和转化经验教训， 实用的政策，组织变革和预防性创新，优化患者- 以健康为中心的结果，并最终减少或消除戏剧性和悲剧性的自杀- 城市AI/AN YYAs之间的相关健康差距。

OVERALL PROJECT SUMMARY Suicide is the second leading cause of death for American Indian and Alaska Natives (AI/AN) ages 10-34, and is up to 6 times higher than for their White counterparts. Native youth also suffer a disproportionate burden of suicide risk factors, including mental health disorders, traumatic life events, and substance abuse. These findings derive largely from research in rural, reservation settings. Yet we know the “invisible tribe” in our cities faces enormous challenges stemming from lack of connection with traditional family and cultural environments. These challenges contribute to the notably greater risk of urban AI/AN youth and young adults (YYAs) compared to their non-AI/AN counterparts for attempted suicide (21% vs. 7%), as well as for depression, substance abuse, gang activity, teen pregnancy, and abuse. Yet calls for thoughtful, pragmatic research to inform suicide prevention among urban AI/AN YYAs have not been answered until now. Our response to RFA-MH-17-350, which seeks to establish collaborative hubs to reduce the burden of suicide among AI/AN YYAs, promises to redress the imbalance between urban and rural emphases in suicide prevention research. The central study, “Suicide Prevention for Urban Native Kids and Youth (SPUNKY),” builds on Screening, Brief Intervention and Referral to Treatment (SBIRT) carried out through primary care setting, to detect and manage suicide risk. This approach is multilevel, targeting both the healthcare system and the individual, and links screening to existing mobile phone technologies shown to promote resilience and to tap the protective benefits of social connectedness. This Collaborative Hub will: 1) evaluate existing SBIRT programs to identify and address factors that affect implementation and prevention of suicide among AI/AN YYA patients served by the Seattle Indian Health Board and First Nations Community Healthsource, the country's largest urban Indian health organizations; 2) conduct a randomized control trial that compares the effectiveness of enhancing these SBIRT programs by sending caring text messages to reduce suicidal ideation, attempts, and hospitalizations, and to increase engagement, social connectedness, and resilience, and 3) perform a systematic economic evaluation of SBIRT and its enhancements to determine their relative effects on the use of healthcare resources and quality of life. Our long-term goal is to disseminate and translate the lessons learned into practical policy, organizational changes, and preventive innovations that optimize patient- centered health outcomes and ultimately reduce or eliminate the dramatic and tragic suicide- related health disparities among urban AI/AN YYAs.