Experiences and Outcomes of Suicidal Individuals with and without Autism in Emergency Departments Nationwide

项目摘要/摘要 在美国，每年有超过50万人因自杀念头而向急诊部(EDs)求诊 (Si)和/或自杀行为(Sb)。离开教育署后，他们短期内多次自我伤害和死亡的风险 自杀率高得出奇。自闭症谱系障碍(ASD)的个体比例不成比例 曾因自杀相关紧急情况在急症室就诊。患有自闭症的人多达9人 发生SI的可能性是普通人群的五倍，企图自杀的可能性是普通人群的五倍。 尽管他们自杀的风险增加，与自杀相关的急诊率也很高，但人们对 自杀的自闭症患者寻求紧急护理的经历或结果。建议的混合方案 方法研究将有助于减少自杀死亡的长期努力，通过告知适应和 为自闭症患者实施预防自杀的循证做法。这项研究 目标是：(A)使用回溯性、纵向设计来比较以下项目的经验和结果 在全国急诊室寻求SI或SB护理的患有和不患有自闭症的个人；以及(B)约谈关键 利益相关者关于如何改进基于ED的自杀预防实践和增加ED后的心理健康 自闭症患者的健康治疗参与度。超过1亿人的公开索赔记录--以及 私人参保的个人将被用来确定和跟踪不同的国家队列患者 与自杀有关的艾德来访。医院和县级信息将从美国医院提取 协会年度调查数据库，SAMHSA全国精神卫生治疗设施调查，以及 区域资源文件。结果变量包括ED出院倾向、门诊精神卫生服务 使用、SI或SB复发，以及自杀死亡(来自国家死亡指数)。半结构化 对患有自闭症和自杀相关急诊科就诊的患者、其家人和急诊科医生的访谈 将详细阐述量化结果，并为未来基于ED的干预措施提供潜在目标 实施战略。结果将帮助美国各地的政策制定者和医护人员更好地 了解自闭症自杀患者的预防和干预要点。这个项目很好- 与机构间自闭症协调委员会减少致残性共生的目标保持一致 ASD患者的心理健康状况和过早死亡率，以及NIMH的重点战略目标4 关于加强NIMH资助的研究对公共健康的影响。

PROJECT SUMMARY/ABSTRACT Over half a million people in the U.S. present annually to Emergency Departments (EDs) for suicidal ideation (SI) and/or suicidal behavior (SB). After leaving the ED, their short-term risk of repeated self-harm and death by suicide are exceptionally high. Individuals with autism spectrum disorder (ASD) are disproportionally represented among those seen in the ED for suicide-related emergencies. Individuals with ASD are up to nine times more likely to experience SI and up to five times more likely to attempt suicide than the general population. Despite their increased risk for suicide and high rates of suicide-related ED visits, little is known about the experiences or outcomes of suicidal individuals with ASD seeking emergency care. The proposed mixed methods study will contribute to long-term efforts to reduce deaths by suicide by informing the adaptation and implementation of evidence-based practices for suicide prevention for individuals with ASD. The study objectives are: (a) to use a retrospective, longitudinal design to compare the experiences and outcomes of individuals with and without ASD who sought care for SI or SB in EDs nationwide; and (b) to interview key stakeholders about ways to improve ED-based suicide prevention practices and increase post-ED mental health treatment engagement for individuals with ASD. Claims records from over 100 million publicly- and privately-insured individuals will be used to ascertain and follow a diverse national cohort of patients with a suicide-related ED visit. Hospital- and county-level information will be drawn from the American Hospital Association Annual Survey Database, SAMHSA National Survey of Mental Health Treatment Facilities, and Area Resource File. Outcome variables include ED discharge disposition, outpatient mental health service utilization, SI or SB recurrence, and death by suicide (from the National Death Index). Semi-structured interviews with individuals with ASD and suicide-related ED visits, their family members, and ED physicians will elaborate upon the quantitative findings and inform potential targets for future ED-based intervention and implementation strategies. Results will help policy makers and healthcare workers across the U.S. to better understand critical points of prevention and intervention for suicidal individuals with ASD. This project is well- aligned with the Interagency Autism Coordinating Committee's objective to reduce disabling co-occurring mental health conditions and premature mortality in people with ASD, and NIMH's Strategic Objective 4 focused on strengthening the public health impact of NIMH-funded research.