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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.

家长奖摘要我们提出了一项严格的随机试验来评估一种创新的阶梯式护理预防自杀对青少年和年轻人的干预，与健康机构发起的零自杀(ZS)计划相比系统。对于这个年龄段的人来说，迫切需要一种有效的ZS策略，因为这是一个发展时期当：1)自杀是第二大死因，死亡人数超过任何疾病；2) 自杀倾向和行为通常首先发生在这个年龄段；3)自杀和自杀未遂的比率 (4)有效的干预可以减少一生中的风险、痛苦和成本。该项目将伙伴关系与拥有强大基础设施和承诺的卫生系统结合在一起与成功实施协作STEP的研究团队一起提高ZS的质量卫生系统中的护理干预，并具有临床、卫生服务、经济和政策方面的专业知识研究和传播。我们将确定并招募300名12-24岁的自杀率升高和SA的年轻人风险。符合条件的青年将被随机分为：1)零自杀最佳做法，强调卫生系统使用ZS工具包提高质量(ZSBP，www.Sprc.org)；或2)ZSBP+阶梯式自杀护理预防。先前的研究证明了类似干预措施在改善患者预后方面的价值，护理比率和护理的连续性--这是ZS努力的一个关键问题，因为许多年轻人过早地停止了护理尽管存在持续的风险。ZSBP+方法使用：1)风险评估，将青少年分流到适当的护理级别；2)护理经理提供CBT和DBT技能培训，并支持初级保健临床医生患者评估和治疗；3)互联网eCBT和治疗DBT技能视频以及培训为低风险青少年提供全天候支持，并加强面对面小组和/或个人治疗高危青少年；以及4)定期监测患者结局，并实时反馈给临床医生促进分级护理算法的决策和使用。干预期为12个月：6 急性治疗6个月，继续治疗6个月。结果在基线和在分别随访3、6和12个月。我们假设，与ZSBP的年轻人相比，年轻人被随机分配到随着时间的推移，ZSBP+的致命性和非致命性SAS的发生率将显著降低(主要结果)，并将显示二次结局的改善(随着时间的推移自杀事件、自残事件、抑郁症状)。我们亦会进行成本效益分析。结果将为卫生系统提供关键信息以及关于通过将最先进的科学与实践相结合来实现ZS目标的潜力的科学质量提升。ZSBP+阶梯式自杀预防护理具有更广泛、持续采用的潜力在卫生系统内和全国传播，加强我们应对ZS挑战的能力。

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。