Innovations in Suicide Prevention Research (INSPIRE)

摘要 尽管联邦和州政府机构采取了密集的预防措施，但自杀现在是第十大原因。 在过去的二十年里，死亡率稳步上升， 生活在2017年。自杀的影响在青少年等弱势群体中尤其严重， 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 数据联系和方法方面的挑战阻碍了预防工作。虽然全国死亡率 众所周知，有可能实施大型自杀预防举措的实体-卫生系统， 保险公司和惩教部门-缺乏相关数据来监测自杀发生率， 在这方面，我们需要制定一项战略，以确保人口的安全，建立基准，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，健康保险或矫正 系统，代表关键错过的机会，实施自杀预防措施。 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（私人和公共），以及死亡率结果的纠正数据， 实施和评估自杀预防措施，以及大型和足够有力的数据集， 丰富的医疗保健访问信息在一个较长的时间内，与严格的研究设计相匹配， 观测数据因此，我们目前的建议的目的是建立一个深入的自杀 监控系统连接多个大型综合数据库，并使用该系统来定义自杀 死亡率基准，识别自杀风险的预测因子，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，我们处于独特的地位，能够满足这些需求。 护理利用研究;我们在严格的流行病学方法应用于大型 链接的数据库;我们建立了全面的，定期更新的数据库， 护理遭遇，公共和私人保险索赔，更正数据，以及自杀死亡， 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 在个人层面上使用所有适当的保障和安全措施。 该项目将是第一个连接这些大型国家和医疗保健系统级数据库的项目， 持续的自杀监测系统，以确定短期和长期的自杀预测，并告知和 评估北卡罗来纳州和美国各地的自杀预防工作。我们预计这种自杀 预防工作将嵌入到医疗保健系统中，在那里可以识别有风险的个人， 因此，预防自杀和减少自杀的社会影响。

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.