Innovations in Suicide Prevention Research (INSPIRE)

摘要 尽管联邦和州政府机构进行了密集的预防工作，自杀现在仍是第十大主要原因 在美国，死亡率在过去20年里稳步上升，并造成超过4.7万人死亡 生活在2017年。自杀的影响在脆弱人群中特别高，如青少年和 以前被监禁的人。自杀企图也会造成很高的情感、身体和经济损失。 虽然许多研究都集中在自杀死亡的原因和预测因素上，但自杀的进展 数据联系和方法挑战阻碍了预防工作。虽然全国的死亡率 已知的是，有潜力实施大规模自杀预防倡议的实体-卫生系统， 保险公司和惩教部门-缺乏相关数据来监测其 建立基准，并建立预防工作的评价框架。许多 自杀身亡的人最近接触过医疗保健、健康保险或惩教所 这意味着严重错失了实施自杀预防措施的机会。 目前的RFA强调了两个关键需求：整合医疗保健的联动监测系统， 保险公司(私营和公共)和具有死亡率结果的矫正数据，以提供一个框架 实施和评估自杀预防举措，以及功能强大的大型数据集 在更长的时期内获得丰富的医疗保健信息，与严格的研究设计相匹配 观测数据。因此，我们在目前的提案中的目标是建立一个深度自杀 连接多个大型综合数据库监视系统，并使用该系统定义自杀 死亡率基准，确定自杀风险的预测因素，生成风险预测工具，评估自杀 预防工作，并建立长期的工作流程协议，以维持监测系统。我们的团队是 通过我们在自杀、心理健康和健康方面的深厚专业知识，处于独特的地位来满足这些需求 护理利用研究；我们在将严格的流行病学方法应用于大型 链接的数据库；我们建立了对代表健康的全面、定期更新的数据库的访问权限 护理遭遇、公共和私人保险索赔、矫正数据和自杀死亡 美国人口众多的州；以及我们在以前的项目中成功地将所有这些数据库连接到 在个人一级使用所有适当的保障措施和安全措施。 该项目将是第一个将这些大型州和医疗保健系统级数据库连接起来的项目，以建立 持续的自杀监测系统，以识别自杀的短期和长期预测因素，并告知和 评估北卡罗来纳州和全美的自杀预防工作。我们预计会发生这样的自杀事件 预防工作将嵌入医疗保健系统，在那里可以识别高危个人并 转送进行预防和护理，从而防止自杀并减少其社会影响。

ABSTRACT Despite intensive prevention efforts from federal and state agencies, suicide is now the 10th leading cause of mortality overall in the US, increasing steadily over the past two decades and claiming more than 47,000 lives in 2017. The impact of suicide is particularly high among vulnerable populations such as adolescents and formerly incarcerated individuals. Suicide attempts also exact a high emotional, physical, and economic toll. Although much research has focused on causes and predictors of death from suicide, progress in suicide prevention has been hampered by data linkage and methodological challenges. While national mortality rates are known, entities with the potential to implement large suicide prevention initiatives – health systems, insurers, and departments of corrections – lack the linked data to monitor suicide incidence in their populations, establish benchmarks, and establish an evaluation framework for prevention efforts. Many individuals who die from suicide have had recent contact with a health care, health insurance, or correctional system, representing critical missed opportunities to implement suicide prevention measures. Two key needs are highlighted by the present RFA: linked surveillance systems that integrate healthcare, insurer (private and public), and correctional data with mortality outcomes to provide a framework for implementing and evaluating suicide prevention initiatives, and large and adequately powered datasets with rich health care access information over an extended period, matched with rigorous study designs for observational data. Therefore, our objective in the current proposal is to establish an in-depth suicide surveillance system linking multiple large, comprehensive databases and use that system to define suicide mortality benchmarks, identify predictors of suicide risk, generate risk prediction tools, evaluate suicide prevention efforts, and establish long-term workflow protocols to sustain the surveillance system. Our team is uniquely positioned to address these needs through our deep expertise in suicide, mental health, and health care utilization research; our extensive experience in application of rigorous epidemiological methods to large linked databases; our established access to comprehensive, regularly updated databases representing health care encounters, public and private insurance claims, corrections data, and suicide deaths in one of the most populous states in the US; and our successful work in prior projects to link all of these databases at the individual level using all appropriate safeguards and security measures. This project will be the first to link these large state- and healthcare system-level databases to establish an ongoing suicide surveillance system to identify short and long term predictors of suicide and to inform and evaluate suicide prevention efforts in North Carolina and across the United States. We anticipate such suicide prevention efforts will get embedded in healthcare systems where at-risk individuals can be identified and referred for prevention and care, thereby preventing suicides and reducing their societal impacts.