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

项目摘要/摘要 这项拟议研究的目标是初步测试和评估校本课程的初步效果。 专门为黑人青年和与黑人青年有关的人量身定做的自杀预防干预(例如， 家庭和学校工作人员)。自杀在2018年被确认为10至14人的第二大死因- 美国一岁的黑人青少年，但几乎没有循证的自杀预防干预措施 旨在说明影响黑人青年自杀风险的文化因素。更进一步--尽管 普遍的以学校为基础的自杀预防方案有很大的潜力来缓解获得自杀机会的差距 心理健康资源--大多数以学校为基础的自杀预防干预措施适用于高中 学生们。一些研究人员已经开始在中学生中实施预防干预 青少年，但我们对普遍的以学校为基础的自杀预防干预可能产生的影响知之甚少 针对居住在服务不足社区的黑人学生。为了弥补这一差距，我们建议修改现有的 对适应文化的内容进行干预，开展一项试点随机对照试验，以评估初步效果； 可容忍性和可行性。自杀迹象(SOS)计划是一项以学校为基础的干预措施，它具有 通过识别知识证明初中生和高中生自杀企图的减少 以及对抑郁和自杀的态度是调节两者之间关系的关键机制 干预措施的参与和自杀企图的显著减少。因此，重要的是要考虑如何 对这两种机制--对抑郁症和自杀的知识和态度--的轻重缓急可能会不同 黑人青年对自杀的认识和态度可能受到文化的约束和影响 被污名化的关于心理健康问题的求助的想法。父母对耻辱和 学校工作人员对自杀预防资源的熟悉程度也可能影响黑人青年的知识 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)量身定做SOS干预视频，包括 克服接受精神健康治疗的耻辱的文化适应战略；(2)发展文化 调整课程，培训家长和学校工作人员：(A)认识黑人青年的自杀风险因素； 和(B)将学生转介到当地的精神健康治疗服务；和(3)进行试点随机对照 评估减少黑人青年自杀的可行性、耐受性和可接受性的试验(n=300) 三种干预条件(标准SOS条件；文化适应SOS条件；文化适应SOS条件 适应SOS+家长和学校人员培训条件)。考试前的分数将在考试后进行比较， 随访3个月，1年。这项研究的结果将促进我们对影响因素的理解 防止黑人青年自杀，同时也为测试和完善研究提供了基础 在更大的学生队列中实施干预的程序。

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.