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Preventing Youth Suicide in Primary Care: A Family Model

在初级保健中预防青少年自杀：家庭模式

基本信息

批准号：
7117436
负责人：
GUY Sigmond DIAMOND
金额：
$ 29.19万
依托单位：
CHILDREN'S HOSP OF PHILADELPHIA
依托单位国家：
美国
项目类别：
财政年份：
2004
资助国家：
美国
起止时间：
2004-09-01 至 2008-08-31
项目状态：
已结题

项目摘要

Youth suicide is a serious public health problem and clinical challenge for medical and behavioral health providers. Yet few preventive interventions have been tested for this population. This project addresses this deficit by testing the efficacy of a brief family therapy for adolescents presenting with serious risk for suicide in a primary care setting. Several innovations characterize the study. First, patients will be identified and treated directly in the primary care setting. Integrating behavioral health services into primary care may a) reduce burden on physicians by promoting parents as safety monitors, b) increase behavioral health treatment adherence, and c) address many underlying family problems associated with suicide. Second, to identify seriously at risk adolescents, we will assess for severe and persistent suicidal ideation and cooccurring depression. Patients will need to score above clinical cutoffs on both ideation (SIQ > 31) and depression (BDI-II >20) at two consecutive appointments (generally within 3 days of each other). Third, treatment will target two of the most critical suicide risk factors: depression and family conflict. Depression is the most consistently associated risk factor for suicide and family conflict is the most common precipitant of completed suicide (20%) and non-fatal suicidal episodes (50%). Fourth, we will use Attachment Based Family Therapy (ABFT; Diamond et al., 2002) as the intervention approach, an efficacious and manualized family therapy model specifically designed for adolescent depression. ABFT has been successful in reducing suicidal ideation, hopelessness, depression, anxiety, and family conflict. The Children's Hospital of Philadelphia's Adolescent Care Center will be the performance site, where typically 1 to 3 adolescents a week present with severe and current ideation. Eighty-seven percent of patients are African American and 60% are girls. One-hundred and twenty adolescents will be randomized to 6 to 10 weeks of either ABFT or Enhanced Usual Care (EUC). Patients will be evaluated at baseline 6, 12, 24, and 52 weeks.

青少年自杀是一个严重的公共卫生问题，也是医疗和行为卫生提供者面临的临床挑战。然而，很少有针对这一人群的预防性干预措施进行测试。该项目通过测试在初级保健环境中出现严重自杀风险的青少年的简短家庭治疗的有效性来解决这一缺陷。这项研究有几项创新之处。首先，将在初级保健环境中直接识别和治疗患者。将行为健康服务整合到初级保健中可以a)通过促进父母作为安全监督者来减轻医生的负担，b)增加行为健康 C)解决与自杀有关的许多潜在的家庭问题。其次，为了识别严重的高危青少年，我们将评估严重和持续的自杀意念和共生抑郁症。患者将需要在两次连续的预约中(通常在彼此之间的3天内)在意念(SIQ&>31)和抑郁(BDI-II&GT；20)上获得高于临床临界值的分数。第三，治疗将针对两个最关键的自杀风险因素：抑郁症和家庭冲突。抑郁是自杀最常见的危险因素，家庭冲突是自杀最常见的诱因完全自杀(20%)和非致命性自杀(50%)。第四，我们将使用基于依恋的家庭治疗(ABFT；戴蒙德等人，2002)作为干预方法，这是一种专门为青少年抑郁症设计的有效和机械化的家庭治疗模式。ABFT已经成功地减少了自杀念头、绝望、抑郁、焦虑和家庭冲突。费城青少年护理中心的儿童医院将是演出地点，通常每周有1到3名青少年出现严重的和当前的想法。87%的患者是非裔美国人，60%是女孩。120名青少年将被随机分配到ABFT或增强型日常护理(EUC)的6到10周。患者将在基线6周、12周、24周和52周进行评估。