Development of an Intervention for Suicide Attempters

自杀和自杀未遂是美国的主要公共卫生问题，2000年自杀导致29，000多人死亡，自杀未遂导致400，000多人住院。尽管近年来我们对许多精神疾病的有效治疗方法的认识有了显著的进步，但这个国家的自杀率并没有大幅下降。尽管自杀具有很高的公共卫生意义，而且我们目前的精神病治疗显然无法影响自杀率，但致力于开发或测试直接针对自杀行为的干预措施的研究相对较少。这种治疗开发补助金旨在通过为以前有自杀企图的个人开发一个综合的，连续的治疗计划来解决这一限制。更具体地说，我们建议制定一项治疗计划，旨在减少高风险样本中随后的自杀行为-自杀企图后入住精神病医院的重度抑郁症成年患者。在其初步形式中，这一干预措施暂命名为应对长期自杀未遂计划（CLASP），由三个主要组成部分组成：a）病人住院期间的三次单独会议，B）一次与患者及其重要其他人的面对面会议，以及c）出院后6个月内与患者和重要他人进行一系列预定电话联系。本申请的总体目标是进一步开发CLASP干预措施，并收集有关该治疗方案疗效的初步数据。具体而言，我们建议：1.为CLASP治疗制定一份全面的治疗手册-一种多模式干预，包括认知行为心理疗法和家庭干预的治疗策略的整合。2.开发，实施和评估治疗师培训计划。3.开发并测试依从性和能力评定量表的信度和效度，以评估治疗师对治疗手册的依从性及其提供治疗的能力。4.在近期有自杀企图的住院患者样本中进行一项随机对照初步研究，以：a）评估拟定治疗的可行性和可接受性，和B）提供CLASP在减少自杀行为方面与增强治疗相比的有效性效应量估计。这项试点研究将为更大规模的临床试验奠定基础，以评估这种新的自杀治疗方法在这一高危患者群体中的疗效。

DESCRIPTION (provided by applicant): Suicide and attempted suicide are major public health issues in the United States, with suicide accounting for more than 29,000 deaths in the year 2000 and attempted suicide accounting for over 400,000 hospital admissions. Although recent years have seen significant advances in our knowledge of efficacious treatments for many psychiatric disorders, the suicide rates in this country have not decreased substantially. Despite the high public health significance of suicide and the apparent inability of our current psychiatric treatments to influence suicide rates, there has been relatively little research devoted to developing or testing interventions that directly target suicidal behavior. This treatment development grant seeks to address this limitation by developing an integrated, adjunctive treatment program for individuals who have made a previous suicide attempt. More specifically, we propose to develop a treatment program aimed at reducing subsequent suicidal behavior in a high risk sample - adult patients with major depression admitted to a psychiatric hospital following a suicide attempt. In its preliminary format, this intervention, tentatively named the Coping Long- term with Attempted Suicide Program (CLASP), is comprised of three major components: a) three individual meetings while the patient is in the hospital, b) one in-person meeting with the patient and his/her significant other(s) and c) a series of scheduled telephone contacts with the patient and significant other for six months following discharge from the hospital. The overall aim of this application is to further develop the CLASP intervention 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 CLASP treatment - a multi-modal intervention that consists of an integration of treatment strategies from cognitive-behavioral psychotherapies and family interventions. 2. Develop, implement and evaluate a therapist training program. 3. Develop and test the reliability and validity of adherence and competence rating scales to evaluate therapists' adherence to the treatment manual and their competence in delivering the treatment. 4. Conduct a randomized controlled pilot study in a sample of inpatients with a recent suicide attempt to: a) assess the feasibility and acceptability of the proposed treatment, and b) to provide an estimate of effect size of the efficacy of CLASP in reducing suicidal behavior in comparison to Enhanced Treatment As Usual. This pilot study will lay the groundwork for a larger clinical trial evaluating the efficacy of this new treatment for suicide in this high risk group of patients.