Developing text-based support for parents of suicidal adolescents after emergency department visits: A multi-component intervention pilot

摘要 青少年自杀是一个紧迫的公共卫生问题。急诊室（ED）通常是第一道 接触大量有自杀倾向的青少年，其中许多人与门诊治疗无关， 出院后自杀危机（自杀企图、因自杀意念而就诊于艾德）的风险仍然很高 和/或行为）。因此，迫切需要为青少年提供有效的连续性护理战略， 从艾德护理过渡的自杀风险升高。其中一种有希望但研究不足的方法是 干预有自杀倾向的青少年的父母。这些高危青少年的父母处于自杀的最前沿 预防，并负责实施出院后自杀预防建议（例如，致命 手段限制，注意自杀警告信号，提供支持，鼓励健康的应对方式等）。在 与此同时，除了感到不知所措之外，家长们还报告说，他们对自己参与的能力信心不足。 建议开展自杀预防活动。这项建议旨在制定和试行一个适应性强、以文本为基础的 对从艾德护理过渡的自杀青年的父母进行干预。干预将包括两个 针对相关领域的短信组件：（1）父母提供以自我为中心（A-F）的支持 促进自杀青少年的安全和福祉;（2）以家长为中心的支援， 提高父母自身的幸福感。因为有自杀倾向的年轻人是高度异质性的--而父母的选择 出院后的挑战和压力可能会有所不同--理想情况下， 以满足父母独特且不断变化的需求。特别是，虽然考虑了A-F支持的所有要素， P-F支持可能需要更大的个性化，以优化出院后的结果。设计成 为了满足个人不断变化的需求，及时适应性干预（JITAIs） 提供基于移动的干预措施，以最大限度地提高成果，同时最大限度地减少负担。为此，P-F 短信部分将包括一个嵌入式微随机试验（MRT）-一个实验设计用于 开发高质量的JITAI。我们的主要目标是：（1）完成A-F和P-F文本组件， 家长的输入（N=25）;（2）试点的文本为基础的干预与90名家长随机分为对照组或 两个为期六周的干预组之一，接受A-F或A-F加P-F短信组件; (3)试行嵌入式MRT，其中父母将每天两次随机分配P-F消息或无消息 条件，告知吉泰的发展。除了可行性和可接受性外， 将在2周、6周和12周内评估机制（父母自我效能）和相关远端结局 出院后。为全面试验奠定了基础，这项研究提供了创新，作为第一个纳入文本 信息传递和MRT，以指导为自杀父母制定基于文本的自适应干预措施 从急诊室出院的青少年。通过解决对有效的连续性护理战略的迫切需要， 对于自杀青年后艾德护理，并提出了一个可扩展的方法，这项研究有可能产生很大的影响。

ABSTRACT Youth suicide is an urgent public health concern. Emergency Departments (EDs) often serve as the first line of contact for large numbers of suicidal adolescents, many of whom do not link to outpatient treatment and continue to be at high risk for post-discharge suicidal crises (suicide attempts, ED visits due to suicidal ideation and/or behavior). Thus, there is a critical need for efficacious continuity of care strategies for adolescents at elevated suicide risk who transition from ED care. One such promising, yet understudied, approach is to intervene with parents of suicidal adolescents. Parents of these high-risk youth are at the forefront of suicide prevention and are tasked with implementing post-discharge suicide prevention recommendations (e.g., lethal means restriction, attending to suicide warning signs, providing support, encouraging healthy coping, etc.). At the same time, in addition to feeling overwhelmed, parents report low confidence in their ability to engage in recommended suicide prevention activities. This proposal seeks to develop and pilot an adaptive, text-based intervention for parents of suicidal youth transitioning from ED care. The intervention will be comprised of two texting components targeting interrelated domains: (1) parental provision of adolescent-focused (A-F) support to promote safety and well-being of suicidal adolescents and (2) parent-focused support (P-F) directed at enhancing parents’ own well-being. Because suicidal youth are highly heterogeneous—and parents’ caregiving challenges and stress may vary in the post-discharge period—a texting intervention should ideally be tailored to meet parents’ unique and changing needs. In particular, while all elements of A-F support are considered essential, P-F support may require greater personalization to optimize post-discharge outcomes. Designed to address the dynamically changing needs of individuals, Just-In-Time Adaptive Interventions (JITAIs) adapt the provision of mobile-based interventions to maximize outcomes while minimizing burden. To this end, the P-F texting component will include an embedded micro-randomized trial (MRT)—an experimental design used for developing high-quality JITAIs. Our primary aims are to: (1) finalize A-F and P-F texting components with parents’ input (N=25); (2) pilot the text-based intervention with 90 parents randomized to a control group or to one of two six-week intervention groups receiving either the A-F or the A-F plus P-F texting components; and (3) pilot the embedded MRT, wherein parents will be randomized twice daily to P-F message or no message condition, to inform the development of a JITAI. In addition to feasibility and acceptability, the proposed mechanism (parental self-efficacy) and relevant distal outcomes will be assessed over 2,- 6-, and 12-weeks post discharge. Setting the stage for a full-scale trial, this study offers innovation as the first to incorporate text messaging and an MRT to guide the development of an adaptive text-based intervention for parents of suicidal adolescents discharged from EDs. By addressing an urgent need for efficacious continuity of care strategies for suicidal youth post ED care, and by proposing a scalable approach, this study has potential for high impact.