DCIPS: Intervention with High Suicide Risk Individuals

描述（由申请人提供）：本申请是对RFA-MH-04-003“发展预防自杀干预中心（DCIPS）”的回应。“虽然美国自杀和自杀未遂的发生率很高，但对这一人群有效治疗的研究却远远落后。自杀干预的随机对照试验，无论是药物或心理社会已经进行了不到40。因此，从临床试验的角度来看，精神病学中最致命的疾病受到的关注最少，许多常用的干预措施从未经过经验测试。 自杀的最重要的风险因素是先前的自杀行为，严重和持续的自杀意念和共病酒精（AUD）和物质使用障碍（SUD）。为了开发对减少自杀企图和自杀有直接影响的干预措施，自杀人群中的这一高危人群是我们中心的重点。将针对易于出口和易于培训的干预措施，如药物战略和简短的心理社会干预措施。 主要目标，每一个培训的组成部分，与高自杀风险的个人，青少年和成人：1。促进、发展和开展有效性研究，以测试和调整针对自杀行为的药理学、心理社会学和综合干预措施; 2.鼓励在干预研究中纳入道德和临床合理的自杀个体，这些个体通常被排除在干预研究之外，目标是他们的原发性疾病，例如抑郁症，双相情感障碍，AUD和SUD; 3.与本地精神科急症室建立伙伴关系和网络模式，为有自杀倾向的人士制订更有效的转介和跟进程序;及4.制定策略，以加强自杀者在急诊室就诊和招募参与干预试验后的治疗参与度、依从性和保留率; 5.为自杀干预试验加强可靠和准确的自杀评估和测量发展;以及6.制定策略，以理解和管理进行自杀干预研究中复杂的临床和伦理问题。

DESCRIPTION (provided by applicant): This application is in response to RFA-MH-04-003, "Developing Centers on Intervention for the Prevention of Suicide (DCIPS)." While there is a high incidence of suicide and suicide attempts in the United States, research on effective treatments for this population has lagged far behind. Fewer than forty randomized controlled trials of suicide interventions, either pharmacological or psychosocial have been conducted. Thus, the most deadly condition in psychiatry has received the least attention from a clinical trials perspective and many commonly used interventions have never been tested empirically. The most significant risk factors for suicide are prior suicidal behavior, serious and persistent suicide ideation and co-morbid alcohol (AUD) and substance use disorders (SUD). In an effort to develop interventions that have a direct impact on reducing suicide attempts and suicide, this high-risk segment of the suicidal population is the focus of our Center. Interventions that are readily exportable and easily trained, such as medication strategies and brief psychosocial interventions will be targeted. The primary goals, each with a training component, are related to high suicide risk individuals, both adolescent and adult: 1. to promote, develop and conduct efficacy studies that test and adapt pharmacological, psychosocial and combined interventions targeting suicidal behaviors; 2. to stimulate ethically and clinically-sound inclusion of suicidal individuals in intervention studies, from which they are typically excluded targeting their primary disorder, e.g. depression, bipolar disorder, AUD and SUD; 3. to develop a model of partnership and network with local Psychiatric Emergency Rooms to develop a more effective referral and follow-up process for suicidal individuals; and 4. to develop strategies to enhance treatment engagement, adherence and retention of suicidal individuals both following ER visits and after recruitment into intervention trials; 5. to enhance reliable and accurate suicide assessment and measurement development for suicide intervention trials; and 6. to develop strategies for understanding and managing the complex clinical and ethical issues in conducting suicide intervention research.