Treatment of Suicide in Alcoholic and Depressed Patients

描述(由申请人提供)：酒精使用障碍和精神健康障碍大量共存。更具体地说，酒精使用障碍和情绪障碍之间有很大的重叠，寻求治疗的酒精使用障碍患者中有三分之一以上患有严重抑郁症。同时患有酒精使用障碍和严重抑郁症的患者是自杀行为风险最高的人之一。尽管有如此高的共病和自杀风险，但几乎没有研究开发或调查治疗方法来减少酒精使用障碍和严重抑郁症患者的自杀行为。这项研究的总体目标是开发T-SAD(酒精和抑郁症患者自杀治疗)作为一种辅助治疗，以减少最近试图自杀的酒精使用障碍和重度抑郁症患者的自杀行为，并收集关于该治疗方案有效性的初步数据。更具体地说，我们建议：1)为T-SAD治疗制定一份全面的治疗手册--一种多模式干预 它包括通过电话实施的动机干预、认知治疗和家庭干预的综合。2)制定、实施和评估治疗师培训计划。3)开发和测试能力和依从性评定量表的信度和效度，以评估培训治疗师执行治疗的能力和评估治疗的可靠实施。4)在最近自杀未遂的酒精使用障碍和严重抑郁症患者样本中进行随机对照初步研究，以评估拟议治疗的可行性和可接受性，并提供与通常治疗相比的效果大小估计。这项先导性研究将为一项更大规模的临床试验(第二阶段)奠定基础，评估这种新的自杀疗法在这一高危患者组中的疗效。

DESCRIPTION (provided by applicant): There is tremendous co-existence of alcohol use disorders and mental health disorders. More specifically, there is a substantial overlap between alcohol use disorders and mood disorders, with over one third of alcohol use disorder patients seeking treatment have comorbid major depression. Patients with comorbid alcohol use disorder and major depression are among those individuals with the highest risk for suicidal behavior. Despite these high levels of comorbidity and suicidal risk, there has been virtually no research developing or investigating treatments to reduce suicidal behavior in patients with comorbid alcohol use disorder and major depression. The overall aim of this study is to develop the T-SAD (Treatment of Suicide in Alcoholic and Depressed patients) treatment as an adjunctive treatment to reduce suicidal behavior for patients with comorbid alcohol use disorder and major depression who have made a recent suicide attempt, and to collect preliminary data on the efficacy of this treatment program. More specifically, we propose to: 1) Develop a comprehensive treatment manual for the T-SAD treatment - a multi-modal intervention which consists of an integration of motivational intervention, cognitive therapy, and family intervention administered by telephone. 2) Develop, implement and evaluate a therapist training program. 3) Develop and test the reliability and validity of competence and adherence rating scales that evaluate the training therapists' ability to perform the therapy and assess the reliable delivery of the treatment. 4) Conduct a randomized controlled pilot study in a sample of patients with alcohol use disorder and major depression who have made a recent suicide attempt to assess the feasibility and acceptability of the proposed treatment, and to provide an estimate of effect size in comparison to treatment as usual. This pilot study will lay the groundwork for a larger clinical trial (Phase II) evaluating the efficacy of this new treatment for suicide in this high-risk group of patients.