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Prevention and Assessment of Risk in Teens (PART) Longitudinal Study

青少年风险预防和评估（PART）纵向研究

基本信息

批准号：
10435006
负责人：
Nadine M. Melhem
金额：
$ 59.56万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-07-17 至 2027-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10435006
关键词：
Address Adolescent Affect Algorithms Anhedonia Belief Black race Caregivers Caring Cellular Phone Childhood Clinic Clinical Data Depression and Suicide Depression screen Discrimination Distress Ecological momentary assessment Electronic Health Record Emergency Situation Ensure Event Feedback Feeling suicidal Focus Groups Funding Goals Grant Health Intervention Interview Knowledge Longitudinal Studies Maps Measures Mediating Mediator of activation protein Medical center Mental Depression Methods Monitor Moods Neighborhoods Patient Self-Report Patients Pediatric Hospitals Performance Philadelphia Physical activity Predictive Analytics Prevention Primary Health Care Provider Randomized Randomized Clinical Trials Readiness Recommendation Recording of previous events Risk Risk Assessment Risk Factors Safety Sampling Services Sleep Disorders Stress Suicide Suicide prevention Teenagers Testing Time Universities Violence Work Youth adolescent suicide aged analytical method base care providers cohort comorbidity data fusion effectiveness implementation study effectiveness testing future implementation health disparity health equity health equity promotion high risk ideation implementation efforts implementation facilitators implementation science improved meetings mobile sensing prediction algorithm preference primary care setting primary outcome protective factors psychosocial recruit reducing suicide response risk stratification routine screening screening service delivery sleep pattern social engagement suicidal suicidal adolescent suicidal behavior suicidal risk suicide attempter suicide rate text messaging intervention tool treatment as usual treatment comparison treatment response

项目摘要

Suicide rates among adolescents have increased dramatically, particularly for Black youth. The majority of suicide decedents have their last clinical contact in primary care. Thus, PPC settings are critical for identifying and treating suicidal youth, but there are challenges with respect to identification, intervention, and implementation. Annual screening for depression using self-report may miss identifying many high-risk youth, as many suicide attempters, particular Black youth, do not report ideation prior to their suicidal behavior and suicidal crises in youth can develop quickly. A second challenge is that once high-risk youth are identified, PPC providers lack a reliable service delivery strategy to effectively treat these youth. A third challenge is that are many barriers for identifying or intervening with Black youth at risk for suicide. Our Signature R01 addresses these challenges as follows: In the first component of the R01, we will develop a predictive analytic platform for PPC based on the electronic health record (EHR), mobile sensing, ecological momentary activity (EMA) assessments of mood and suicidal thoughts and behaviors and self-reports to identify who is at risk and when they are at imminent risk for suicide-related events. To accomplish this, we will recruit 2000 youth from PPC, enriched for those at high suicidal risk, and the sample will be 35% Black. These youth will be followed with interviews and self-reports at 1, 3, and 6 months following baseline and will have 6 months of data from mobile sensing and daily and weekly EMA. We will: (1) develop a predictive algorithm using EHR of adolescents in PPC settings; (2) identify dynamic changes in mobile sensing and EMA measures predicting imminent risk for suicide- related events; (3) develop a data-fusion algorithm combining mobile sensing, EMA, self-reports, and EHR to improve prediction; and (4) test and optimize its performance among Black youth. In the 2nd component, we will conduct a randomized clinical trial (RCT) on a subset of this cohort, namely 900 youth at high suicidal risk. We will compare treatment as usual (TAU) to a suite of tools developed in the current project period to guide the pediatric provider in assessing suicidal risk, making a treatment recommendation, generating a safety plan that is loaded on the patient’s smartphone, and launching an automated texting intervention to increase treatment engagement. Based on our previous work, we hypothesize that this combined intervention, integrated Care to Help At-Risk Teens (iCHART) will decrease suicidal events (suicidal behavior or ideation that results in an emergency referral) by 50%, and the effects will be mediated by increases in referrals, treatment engagement, and safety planning. We will use implementation science methods to assess barriers, facilitators, feasibility, and acceptability of PART predictive analytics and the iCHART intervention to inform future implementation efforts and to promote health equity and ensure that our methods of identification and intervention will be effective and acceptable to Black youth. This study can improve identification and monitoring of youth at risk, reduce suicidal events, and advance health equity for Black youth.

青少年的自杀率急剧上升，尤其是黑人青少年。大部分自杀者最后一次临床接触是在初级保健机构。因此，PPC 设置对于识别至关重要和治疗有自杀倾向的青少年，但在识别、干预和治疗方面存在挑战执行。每年使用自我报告进行抑郁症筛查可能会漏掉许多高危青少年，因为许多自杀未遂者，特别是黑人青年，在他们的自杀行为之前并没有报告意念，并且青少年的自杀危机可能会迅速发展。第二个挑战是，一旦确定了高危青少年，PPC 提供者缺乏可靠的服务提供策略来有效治疗这些青少年。第三个挑战是识别或干预有自杀风险的黑人青少年面临许多障碍。我们的签名 R01 地址这些挑战如下：在 R01 的第一个组成部分中，我们将开发一个预测分析平台基于电子健康记录（EHR）、移动传感、生态瞬时活动（EMA）的PPC 评估情绪和自杀想法和行为以及自我报告，以确定谁有风险以及何时有风险他们面临自杀相关事件的迫在眉睫的风险。为了实现这一目标，我们将从 PPC 招募 2000 名年轻人，针对那些自杀风险较高的人进行了丰富，样本中黑人比例为 35%。这些年轻人将跟随基线后 1、3 和 6 个月的访谈和自我报告，并将有 6 个月来自移动设备的数据感应以及每日和每周 EMA。我们将： (1) 在 PPC 中使用青少年 EHR 开发预测算法设置; (2) 识别移动传感和 EMA 测量的动态变化，预测迫在眉睫的自杀风险相关事件； (3) 开发一种结合移动传感、EMA、自我报告和 EHR 的数据融合算法改进预测； (4) 在黑人青年中测试并优化其表现。在第二个组件中，我们将对该队列的一个子集（即 900 名自杀风险较高的青少年）进行随机临床试验 (RCT)。我们将把照常治疗 (TAU) 与当前项目期间开发的一套工具进行比较，以指导儿科服务提供者评估自杀风险、提出治疗建议、制定安全计划被加载到患者的智能手机上，并启动自动短信干预以增加治疗订婚。根据我们之前的工作，我们假设这种联合干预、综合护理帮助高危青少年 (iCHART) 将减少自杀事件（导致自杀的行为或意念）紧急转诊）50%，效果将通过转诊、治疗参与度的增加来调节，和安全规划。我们将使用实施科学方法来评估障碍、促进因素、可行性和 PART 预测分析和 iCHART 干预的可接受性，为未来的实施工作提供信息促进健康公平并确保我们的识别和干预方法有效且黑人青年可以接受。这项研究可以改善对高危青少年的识别和监测，减少自杀率活动，并促进黑人青年的健康公平。