Innovations in Suicide Prevention Research (INSPIRE)

自杀预防研究的创新（INSPIRE）

• 批准号: 10457534
• 负责人: Brian W Pence
• 金额: $ 6.1万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-09 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10457534
• 关键词: Address; Adolescent; Age; Benchmarking; Caring; Cessation of life; Clinic; Clinical; Data; Data Linkages; Data Set; Databases; Death Records; Economics; Emotional; Epidemic; Epidemiologic Methods; Evaluation; Future; General Population; Health Insurance; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Hospitals; Imprisonment; Incidence; Individual; Inpatients; Insurance; Insurance Carriers; Interruption; Link; Long-Term Care; Machine Learning; Medicaid; Mental Health; Methodology; Monitor; North Carolina; Outcome; Patients; Pattern; Persons; Policies; Population; Positioning Attribute; Prevention; Prevention Measures; Prevention Research; Prisons; Privatization; Protocols documentation; Provider; Recording of previous events; Records; Registries; Reporting; Research; Research Design; Risk; Risk Assessment; Sampling; Security Measures; Suicide; Suicide attempt; Suicide prevention; System; Target Populations; Time; Time Series Analysis; United States; Update; Violence; Vulnerable Populations; Work; Youth; base; case control; clinical predictors; correctional system; cost; density; design; experience; health care availability; health care service utilization; high risk; innovation; insurance claims; mortality; mortality risk; patient population; population based; prevention evaluation; preventive intervention; prospective; risk prediction; study population; suicidal morbidity; suicidal risk; suicide mortality; tool; years of life lost; young adult

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.

抽象的 尽管联邦和州机构采取了大力预防措施，但自杀目前已成为第十大原因 美国总体死亡率在过去二十年中稳步上升，死亡人数超过 47,000 2017 年的生活。自杀对青少年和青少年等弱势群体的影响尤其严重。 以前被监禁的人。自杀企图也会造成高昂的情感、身体和经济损失。 尽管许多研究都集中在自杀死亡的原因和预测因素上，但自杀方面的进展 数据链接和方法挑战阻碍了预防工作。虽然全国死亡率 众所周知，有潜力实施大规模自杀预防举措的实体——卫生系统、 保险公司和惩教部门 – 缺乏监测自杀发生率的关联数据 人口，制定基准，并建立预防工作的评估框架。许多 死于自杀的人最近接触过医疗保健、健康保险或惩教机构 系统，这意味着错失了实施自杀预防措施的关键机会。 目前的 RFA 强调了两个关键需求：整合医疗保健的链接监控系统， 保险公司（私人和公共）和带有死亡率结果的惩教数据，为 实施和评估自杀预防举措，以及大型且充足的数据集 长期丰富的医疗保健获取信息，与严格的研究设计相匹配 观察数据。因此，我们当前提案的目标是建立一个深度的自杀机制。 连接多个大型综合数据库的监视系统，并使用该系统来定义自杀 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深厚的专业知识，我们拥有独特的优势来满足这些需求 护理利用研究；我们在大规模应用严格的流行病学方法方面拥有丰富的经验 链接数据库；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 护理经历、公共和私人保险索赔、惩教数据和自杀死亡人数最多的国家之一 美国人口稠密的州；以及我们在之前项目中成功连接所有这些数据库的工作 个人层面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国家和医疗保健系统级数据库连接起来以建立一个 持续的自杀监测系统，以确定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美国各地的自杀预防工作。我们预计会有这样的自杀事件 预防工作将融入医疗保健系统，可以识别高危人群并 转介进行预防和护理，从而预防自杀并减少其社会影响。