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

• 批准号: 7096515
• 负责人: GUY Sigmond DIAMOND
• 金额: $ 29.75万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-01 至 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7096515
• 关键词: African American; adolescence (12-20); behavioral /social science research tag; behavioral medicine; clinical research; depression; developmental psychology; disease /disorder proneness /risk; family structure /dynamics; family therapy; human subject; human therapy evaluation; longitudinal human study; mental disorder diagnosis; mental disorder prevention; outcomes research; patient oriented research; primary care physician; suicide; therapy compliance

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，也是医疗和行为健康提供者面临的临床挑战。然而，针对这一人群测试的预防性干预措施却很少。该项目通过测试对初级保健机构中存在严重自杀风险的青少年进行简短家庭治疗的效果来解决这一缺陷。这项研究有几个创新之处。首先，将在初级保健机构中直接识别和治疗患者。将行为健康服务纳入初级保健可以 a) 通过促进父母作为安全监督员来减轻医生的负担，b) 增强行为健康 治疗依从性，以及 c) 解决许多与自杀相关的潜在家庭问题。其次，为了识别处于严重危险中的青少年，我们将评估严重且持续的自杀意念和并发抑郁症。患者需要在连续两次就诊（通常相隔 3 天内）的意念 (SIQ > 31) 和抑郁 (BDI-II >20) 方面得分均高于临床临界值。第三，治疗将针对两个最重要的自杀危险因素：抑郁和家庭冲突。抑郁症是与自杀最相关的危险因素，而家庭冲突是自杀最常见的诱因。 完成自杀（20%）和非致命性自杀事件（50%）。第四，我们将使用基于依恋的家庭治疗（ABFT；Diamond et al., 2002）作为干预方法，这是一种专门针对青少年抑郁症设计的有效且手动的家庭治疗模式。 ABFT 已成功减少自杀意念、绝望、抑郁、焦虑和家庭冲突。费城儿童医院的青少年护理中心将成为表演场地，通常每周有 1 至 3 名青少年出现严重且当前的想法。 87% 的患者是非裔美国人，60% 是女孩。一百二十名青少年将被随机分配接受为期 6 至 10 周的 ABFT 或强化日常护理 (EUC)。患者将在基线第 6、12、24 和 52 周时接受评估。