Piloting a culturally adapted multilevel suicide prevention intervention in schools for Black youth and their families

项目概要/摘要 本研究的目的是试点测试并评估校本计划的初步有效性 专门为黑人青年和与黑人青年有关的人（例如， 家庭和学校人员）。 2018 年，自杀被认为是 10 至 14 岁人口的第二大死因 美国 1 岁黑人青少年，但缺乏基于证据的自杀预防干预措施 旨在考虑影响黑人青年自杀风险的文化因素。更进一步——尽管 以学校为基础的普遍自杀预防方案具有巨大的潜力，可以减少获得自杀服务的机会的差距 心理健康资源——大多数以学校为基础的自杀预防干预措施是针对高中进行的 学生。一些研究人员已经开始在中学生中实施预防干预措施 年轻人，但我们对基于学校的普遍自杀预防干预措施可能产生的效果知之甚少 为居住在服务欠缺社区的黑人学生提供服务。为了弥补这一差距，我们建议修改现有的 通过进行试点随机对照试验来评估初步效果，对适应文化的内容进行干预， 耐受性和可行性。自杀迹象 (SOS) 计划是一项以学校为基础的干预措施， 通过识别知识，中学生和高中生的自杀企图减少 以及对抑郁和自杀的态度作为调解两者关系的关键机制 干预参与和自杀企图显着减少。因此，重要的是要考虑如何 对于抑郁症和自杀的认识和态度这两种机制的优先顺序可能会有所不同 黑人青年对自杀的认识和态度可能受到文化的束缚和影响 关于因心理健康问题而寻求帮助的污名化信念。家长对耻辱的看法 学校人员对自杀预防资源的熟悉程度也可能影响黑人青少年的知识 和态度，从而肯定了多层次自杀预防干预的必要性。因此我们建议 SOS 计划的文化改编，旨在：1) 定制 SOS 干预视频，包括 适应文化的策略，消除接受心理健康治疗的耻辱； （二）文化发展 调整课程，培训家长和学校人员 (a) 认识黑人青少年的自杀风险因素； (b) 将学生转介至当地的心理健康治疗服务机构； (3) 开展随机对照试点 试验（n=300）评估减少黑人青年自杀的可行性、耐受性和可接受性 跨越三种干预条件（标准 SOS 条件；文化适应的 SOS 条件；文化上的 SOS 条件） 适应SOS家长和学校人员培训条件）。考前成绩将在考后进行比较， 3个月和1年的随访。这项研究的结果将加深我们对影响因素的理解 并防止黑人青少年自杀，同时也为测试和完善研究提供基础 对更多学生实施干预的程序。

Project Summary/Abstract The goal of this proposed study is to pilot test and evaluate the preliminary effectiveness of a school-based suicide prevention intervention tailored specifically for Black youth and those connected to Black youth (e.g., families and school personnel). Suicide was recognized in 2018 as the 2nd leading cause of death for 10 to 14- year-old Black adolescents in the U.S., yet there are few evidence-based suicide prevention interventions designed to account for the cultural factors that influence Black youth's risks for suicidality. Further – although universal school-based suicide prevention programs have great potential to alleviate disparities in access to mental health resources – most school-based suicide prevention interventions are administered to high school students. Some researchers have begun to implement prevention interventions among middle school-aged youth, but we know little about the effect universal school-based suicide prevention interventions could have for Black students residing in underserved communities. To redress this gap, we propose modifying an existing intervention with culturally adapted content by conducting a pilot RCT to assess preliminary effectiveness, tolerability, and feasibility. The Signs of Suicide (SOS) program is a school-based intervention that has demonstrated reductions in suicide attempts among middle and high school students by identifying knowledge and attitudes towards depression and suicide as key mechanisms that mediate the relation between intervention participation and a significant reduction in suicide attempts. Thus, it is important to consider how prioritizing these two mechanisms – knowledge and attitudes towards depression and suicide – may differ for Black youth whose perceptions of knowledge and attitudes of suicide may be culturally bound and influenced by stigmatized beliefs regarding help-seeing for mental health concerns. Parents views about stigma and school personnel's familiarity with suicide prevention resources may also influence Black youth's knowledge and attitudes, thus affirming the necessity of a multilevel suicide prevention intervention. We therefore propose a cultural adaptation of the SOS program that aims to: 1) Tailor the SOS intervention videos to include culturally adapted strategies for navigating stigma of receiving mental health treatment; (2) Develop culturally adapted curricula that trains parents and school personnel to (a) recognize suicide risk factors for Black youth; and (b) refer students to local mental health treatment services; and (3) Conduct a pilot randomized controlled trial (n=300) to assess feasibility, tolerability, and acceptability of reducing suicidality among Black youth across three intervention conditions (standard SOS condition; culturally adapted SOS condition; culturally adapted SOS + parent and school personnel training condition). Pre-test scores will be compared at post-test, 3-month, and 1-year follow up. Results from this study will advance our understanding of factors that contribute to and protect against suicidality in Black youth, while also providing a foundation to test and refine study procedures to implement the intervention in a larger cohort of students.