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Randomized Trial of Stepped Care for Suicide Prevention in Teens and Young Adults

青少年和年轻人预防自杀的阶梯式护理的随机试验

基本信息

批准号：
10468491
负责人：
Joan Rosenbaum Asarnow
金额：
$ 17.43万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-01 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10468491
关键词：
Accounting Acute Adolescent and Young Adult Adoption Age Algorithms Award Behavior Caring Case Manager Cause of Death Cessation of life Clinical Continuity of Patient Care Cost Effectiveness Analysis Decision Making Development Economic Policy Emergency medical service Enrollment Evaluation Event Feedback Goals Health Information System Health Sciences Health Services Health system Individual Infrastructure Internet Intervention Medical Names Outcome Parents Patient Monitoring Patient-Focused Outcomes Patients Persons Primary Health Care Randomized Research Risk Risk Assessment Savings Science Self-Injurious Behavior Suicide Suicide attempt Suicide prevention Teenagers Testing Therapeutic Time Training Support Triage Youth age group cost depressive symptoms effective intervention evidence base high risk improved innovation premature preventive intervention primary care services primary outcome programs randomized trial research data dissemination secondary outcome skills skills training suicidal suicide rate young adult

项目摘要

Parent Award Abstract We propose a rigorous randomized trial to evaluate an innovative stepped care for suicide prevention intervention for adolescents and young adults, compared to a zero suicide (ZS) program initiated by a health system. An effective ZS strategy for this age group is critically needed because this is a developmental period when: 1) suicide is the second leading cause of death, accounting for more deaths than any medical illness; 2) suicidal tendencies and behaviors often first occur in this age span; 3) rates of suicide and suicide attempts (SAs) increase dramatically; and 4) effective intervention can reduce risk, suffering, and costs over lifetimes. The project combines a partnership with a health system that has strong infrastructure and commitment to quality improvement for ZS with a research team that has successfully implemented collaborative stepped care interventions in health systems and has expertise in clinical, health services, economics, and policy research and dissemination. We will identify and enroll 300 youths ages 12-24 with elevated suicide and SA risk. Eligible youths will be randomized to: 1) zero suicide best practices, which emphasizes health system quality improvement using the ZS toolkit (ZSBP, www.sprc.org); or 2) ZSBP+ stepped care for suicide prevention. Prior research demonstrates the value of similar interventions for improving patient outcomes, rates of care, and continuity of care- a critical issue for ZS efforts, as many youths discontinue care prematurely despite continuing risk. The ZSBP+ approach uses: 1) risk assessments to triage youths to appropriate care levels; 2) Care Managers to deliver CBT and DBT skills training and support primary care clinicians with patient evaluation and treatment; 3) internet eCBT and therapeutic DBT skills video plus access to coaching support (24/7) for lower risk youths, with stepped up in-person group and/or individual treatment added for higher risk youths; and 4) regular monitoring of patient outcomes, with real-time feedback to clinicians to facilitate decision-making and use of the stepped care algorithms. The intervention period is 12 months: 6 months of acute treatment; and 6 months of continuation treatment. Outcomes are assessed at baseline and at 3, 6 and 12-month follow-ups. We hypothesize that, compared to youths in ZSBP, youths randomized to ZSBP+ will have significantly lower rates of fatal and nonfatal SAs over time (primary outcome) and will show improvements on secondary outcomes (suicide events over time, self-harm episodes, depressive symptoms). We will also conduct cost effectiveness analyses. Results will provide critical information for health systems and science regarding the potential to achieve ZS goals by integrating state of the art science with practice quality improvement. ZSBP+ stepped care for suicide prevention has potential for broader sustained adoption within the health system and national dissemination, enhancing our capacity to meet the ZS challenge.

家长奖摘要

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

The Emergency Department: Challenges and Opportunities for Suicide Prevention.

DOI：
10.1016/j.chc.2017.05.002
发表时间：
2017-10
期刊：
Child and adolescent psychiatric clinics of North America
影响因子：
2.4
作者：
Asarnow JR;Babeva K;Horstmann E
通讯作者：
Horstmann E

Stepped care for suicide prevention in teens and young adults: Design and methods of a randomized controlled trial.

青少年和年轻人自杀预防的分级护理：随机对照试验的设计和方法。

DOI：
10.1016/j.cct.2022.106959
发表时间：
2022
期刊：
Contemporary clinical trials
影响因子：
2.2
作者：
Sheppler,ChristinaR;Edelmann,AnnaC;Firemark,AlisonJ;Sugar,CatherineA;Lynch,FrancesL;Dickerson,JohnF;Miranda,JeanneM;Clarke,GregoryN;Asarnow,JoanR
通讯作者：
Asarnow,JoanR

Age-Associated Differences in Mental Distress Among Sexual and Gender Minority Adults.

性少数和性别少数成年人的精神困扰与年龄相关的差异。