Effectiveness of a Targeted Brief Intervention for Recent Suicide Attempt Survivors

美国自杀率上升，100多万美国人试图自杀 年。对企图自杀的人进行有效、简短、低成本的干预是拯救生命和 实现国家预防自杀战略的目标。这项提议利用了一段时间- 测试未遂自杀短期干预计划有效性的敏感研究机会 (ASSIP)，针对最近自杀未遂幸存者的手动3次干预，产生了戏剧性的 在有效性试验中减少自杀企图--再次自杀次数减少80%，住院时间平均减少72% 与对照组相比，干预组的天数超过24个月。我们的研究现在将测试它的 美国公共精神卫生保健系统的有效性，检查理论上扎根的机制，以及 探索成本效益。ASSIP目前正由纽约州在一项零自杀倡议中实施 由SAMHSA资助。与NIMH利益通知MH-17-031一致，我们的项目利用了这一联邦 投资和强大的国家合作伙伴关系，以进行有效性研究。我们的项目有三个目标： 目标1.有效性。这项研究的主要目的是确定ASSIP在减少 在美国社区精神卫生环境中再次自杀。为了实现这一目标，我们将进行一项 从精神科住院和急救中心转诊的400人的随机对照试验 在一次自杀未遂之后。参与者将随机接受常规护理+ASSIP(干预 或仅常规护理(对照组)，并在基线、3、6、12和18个月进行评估。 目标2.机制。本研究的次要目的是探讨ASSIPAS的心理机制 自杀的人际关系理论所预言的。我们将对调解模式进行统计分析，以 确定(A)ASSIP是否改善了人们对低归属感和对他人的负担的看法，以及(B) 治疗对减少自杀再次尝试的效果是否通过这些改善而起作用。 目标3.成本效益这项研究的探索性目的是从一个 ASSIP提供者，通过提供ASSIP来补充常规护理来避免每次自杀未遂的增量成本 在一次自杀未遂之后。我们将收集实施前的会计数据、人员时间日志和12- 月急诊和住院精神科就诊的医疗记录报告。我们将一起使用这些数据 计算增量成本-效果比(ICER)。这项时间敏感的研究 将有效性研究纳入联邦政府资助的纽约州零自杀拨款，与 NIMH对此类应用的具体请求。如果假设得到支持，这项研究将提供证据 一种简单、实用和新颖的疗法，在现实世界的健康环境中减少自杀未遂。 如果假设得到支持，这项研究将提供一种简短、实用和新颖的治疗方法来减少 在真实世界的健康环境中再次自杀。

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.