RCT of Gatekeeper Training for Suicide Prevention

描述(由申请人提供)：针对对旨在预防自杀的干预措施进行科学严格评估的需要，提出了一项基于学校的看门人培训计划的随机对照试验(RCT)。自杀是美国15-24岁青少年的第三大死因，与美国总人口相比，青少年自杀率显著上升。R34为QPR看门人培训计划的第三阶段学校一级RCT寻求资金，该计划嵌入了佐治亚州科布县一个大地区的战略预防计划。科布县学校选择在2003年秋季实施QPR看门人培训。QPR是一种常用的看门人培训干预措施，旨在加强对自杀学生的早期发现和他们向精神健康服务机构的转介。在这项为期3年的研究中，将随机选择科布县一半的初中和高中在2003-2004年间接受全校教职员工的QPR培训。其余学校将在2004-2005年期间接受培训。QPR在改善早期发现自杀学生(目标1)方面的准确性和有效性将通过比较以下方面的干预和对照学校比率来检验：(A)转介学生自杀行为或意念的转介和心理健康专业人员的后续评估；(B)所有15,000名8年级和10年级学生自我报告的自杀意念和行为；以及(C)所有青少年自杀死亡。为探讨持续质素保证过程对学校教职员对自杀及转介自我效能认知的影响(目标2)，我们会使用(A)8,720名教职员的前测及后测数据，(B)来自640名教职员的更详细纵向数据，以及(C)采用个案队列设计访问60名教职员。在目标3和4中，我们将结合这些数据和其他数据来检查QPR影响的变化，以及导致QPR成功或不成功地融入学校和心理健康系统的个人和系统层面因素。这项研究将导致对看门人培训计划的第一次随机试验，从而解决确定有效计划的迫切需要。这些设计和分析方法将作为严格评估其他自杀预防计划和其他低基准率条件的模型。

DESCRIPTION (provided by applicant): A school-based randomized controlled trial (RCT) of a gatekeeper-training program is proposed in response to the need for scientifically rigorous evaluations of interventions intended to prevent suicide. Suicide is the third leading cause of death among 15-24 years olds in the US, and rates of suicide among adolescents have increased markedly relative to the aggregate US population. R34 funding is sought for a Phase-III school level RCT of the QPR gatekeeper-training program that is embedded with the strategic prevention plan for a large district, Cobb County, Georgia. Cobb County Schools selected QPR Gatekeeper Training to implement in Fall 2003. QPR is a commonly used gatekeeper training intervention designed to enhance early detection of suicidal students and their referrals to mental health services. For this 3-year study, one-half of Cobb County middle and high schools will be randomly selected to receive QPR training of all school staff during 2003-2004. The remaining schools will be trained during 2004-2005. The accuracy and effectiveness of QPR in improving early detection of suicidal students (Aim 1) will be tested by comparing intervention and control school rates of: (a) referrals of students for suicidal behavior or ideation and follow-up assessments by mental health professionals; (b) all 15,000 8th and 10th grade students' self-reported suicidal ideation and behavior; and (c) all juvenile deaths due to suicide. To examine the impact over time of QPR on school staff members' knowledge of suicide and self-efficacy involving referral (Aim 2) we will use (a) pretest and posttest data on 8,720 staff, (b) more detailed longitudinal data from 640 staff, and (c) interviews of 60 school staff using case-cohort design. In Aims 3 and 4 we will combine these and other data to examine variation in QPR impact and individual and system level factors that lead to successful or unsuccessful integration of QPR into the schools and mental health system. This study would lead to the very first randomized trial of a gatekeeper training program, thus addressing an urgent need to identify effective programs. The designs and analytic methods would serve as a model for the rigorous evaluation of other suicide prevention programs and other low base-rate conditions.