2/4 Adapting Treatments for Suicidal College Students: A Multisite Trial

2/4 针对自杀大学生的调整治疗：多地点试验

• 批准号: 10427323
• 负责人: SCOTT N COMPTON
• 金额: $ 52.22万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10427323
• 关键词: Address; Age; Algorithms; Base Sequence; Behavior; Caring; Cause of Death; Characteristics; Client; Clinical Trials; Clinical effectiveness; Cognition; Consultations; Counseling; Data; Development; Dialectical behavior therapy; Distress; Ecological momentary assessment; Enrollment; Evidence based intervention; Experimental Designs; Feeling suicidal; Heterogeneity; Individual; Intervention; Maintenance; Mediating; Mediator of activation protein; Mental Health Services; Methods; Nevada; Oregon; Participant; Pattern; Phase; Pilot Projects; Process; Provider; Public Health; Randomized; Research Project Grants; Resources; Risk; Risk Factors; Risk Reduction; Role; Sampling; Sequential Multiple Assignment Randomized Trial; Services; Severities; Sexual and Gender Minorities; Site; Specific qualifier value; Stress; Students; Suicide; Suicide attempt; Telephone; Testing; Text; Time; Treatment outcome; Universities; Use Effectiveness; Work; adaptive intervention; attentional bias; base; care seeking; clinical decision-making; college; comparative efficacy; cost effectiveness; data management; dosage; effectiveness evaluation; emerging adulthood; emotion regulation; evidence base; follow-up; implementation barriers; implementation evaluation; implementation framework; implementation outcomes; implementation science; improved; individualized medicine; innovation; multi-site trial; non-suicidal self injury; peer; primary outcome; process evaluation; recruit; response; secondary outcome; skills; success; suicidal; suicidal behavior; suicidal risk; theories; treatment as usual; treatment effect; treatment response; treatment strategy; university student

Project Summary Suicide is the 2nd leading cause of death among college students and suicidal ideation and suicide-related behaviors are a frequent presenting problem at college counseling centers (CCCs), which are overburdened. Studies show that some students respond rapidly to treatment, whereas others require considerably more resources. Evidence-based adaptive treatment strategies (ATSs) are needed to address this heterogeneity in responsivity and complexity. ATSs individualize treatment via decision rules specifying how the type and intensity of an intervention can be sequenced based on risk factors, response, or compliance. We are proposing a multisite study to investigate ATSs through a SMART (sequential, multiple assignment, randomized trial) to address suicidal risk in treatment-seeking college students. This multisite study (University of Nevada, Reno; Duke University, University of Oregon; Rutgers University), submitted in response to RFA- MH-18-700, Collaborative R01s for Clinical Trials, will enroll moderately to severely suicidal college students in the “emerging adulthood” phase (ages 18-25) seeking services at CCCs. This SMART will have two stages of intervention. In the first stage, 700 participants from four CCCs will be randomized to 4-8 weeks of: 1) a suicide-focused treatment – Collaborative Assessment and Management of Suicidality (CAMS) or 2) Treatment as Usual (TAU). Sufficient responders to either intervention will discontinue services/be stepped down. Non- responders will be re-randomized to one of two second-stage higher intensity/dosage intervention options for an additional 4-16 weeks: 1) CAMS (either continued or administered for the first time) or 2) Comprehensive Dialectical Behavior Therapy (DBT), which includes individual therapy, skills groups, and phone/text coaching for the clients and peer consultation for the therapists. The aims of this research project are to 1) compare the efficacy of the four ATSs in reducing students’ suicidal ideation, non-suicidal self-injury, and suicide attempts; 2) evaluate whether, as hypothesized, a sequence that starts with a suicide-focused treatment approach (i.e., CAMS) is more effective in reducing suicidal risk than TAU; 3) determine whether, as hypothesized, a more comprehensive, suicide-focused approach (i.e., DBT) is more helpful as a second stage intervention for insufficient responders, relative to a less intensive suicide-focused approach (i.e., CAMS); 4) assess the mechanisms of change leading to reduced suicidal risk for each treatment; specifically, to evaluate suicidal cognitions as a mediator in CAMS and emotion regulation-based processes and use of skills as mediators in DBT; 5) examine baseline factors as predictors and/or moderators of treatment outcome; 6) evaluate the dissemination potential and cost effectiveness of using these ATSs within a CCC setting. This study will provide essential guidance to CCCs on how to best allocate limited resources to alleviate an increasing public health crisis.

项目摘要 自杀是大学生中的第二大死亡原因，自杀和自杀有关 行为是大学咨询中心（CCC）经常提出的问题，这些问题负担沉重。 研究表明，有些学生对治疗的反应迅速，而另一些学生需要更多 资源。需要循证自适应治疗策略（ATS）来解决这种异质性 响应性和复杂性。 ATSS通过决策规则个性化治疗，指定类型和 干预的强度可以根据风险因素，响应或依从性进行测序。我们是 提出一项多站点研究，以通过智能（顺序，多个分配， 随机试验）以解决寻求治疗的大学生自杀风险。这项多站点研究（大学 里诺内华达州的内华达；俄勒冈大学杜克大学；罗格斯大学（Rutgers University），提交响应RFA- MH-18-700，用于临床试验的合作R01，将适度地入学到严重自杀的大学生中 在CCCS寻求服务的“新兴成年”阶段（18-25岁）。这个智能将有两个阶段 干涉。在第一阶段，来自四个CCC的700名参与者将被随机分配到4-8周的：1）a 以自杀为中心的治疗 - 自杀性的合作评估和管理（CAM）或2）治疗 像往常一样（tau）。足够的响应者对任何一种干预措施都将停止服务/辞职。非- 响应者将被重新转换为两个第二阶段的强度/剂量干预选项之一 另外4-16周：1）凸轮（首次继续或管理）或2）综合 辩证行为疗法（DBT），其中包括个人疗法，技能组和电话/文字教练 为治疗师的客户和同行咨询。该研究项目的目的是1）比较 这四个ATS在减少学生的自杀想法，非自杀的自我伤害和自杀企图方面的功效； 2）评估是否以自杀为中心的治疗方法开头的序列（即 凸轮）比tau更有效地降低自杀风险； 3）确定是否有更多 全面，以自杀为中心的方法（即DBT）作为第二阶段干预的帮助 相对于以自杀为重点的方法（即CAMS），反应者不足； 4）评估 变化的机制导致每种治疗的自杀风险降低；具体而言，评估自杀 认知作为CAM和情绪调节过程中的调解人，并将技能作为调解人的使用 DBT; 5）将基线因子作为治疗结果的预测因素和/或主持人； 6）评估 在CCC设置中使用这些ATS的传播潜力和成本效益。这项研究会 为CCC提供有关如何最好地分配有限资源以减轻公众越来越多的公众的基本指导 健康危机。