Coping Long-Term with Attempted Suicide Program - Adolescents

自杀是15-24岁年龄组的第三大死亡原因，死亡人数超过所有自然原因的总和。2007年，14.5%的美国高中生认真考虑过自杀，6.9%的学生报告在过去12个月内至少有一次自杀企图，2%的学生报告在过去12个月内至少有一次自杀企图需要医疗照顾。尽管自杀和自杀未遂具有很高的公共卫生意义，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。青少年自杀没有金标准治疗;对已发表的青少年自杀随机对照试验的回顾得出结论，迄今为止的治疗效果最低。因此，考虑新的多模式的干预措施，可以适用于自杀的青少年在高风险的过渡期，从住院到门诊治疗，无论诊断，显然是必要的。 这项R34治疗开发赠款的目的是开发“应对长期自杀未遂计划-青少年（CLASP-A）”，这是一项针对曾有自杀企图的青少年的综合性干预计划。CLASP-A的目标是减少持续的自杀行为和意念，减少自杀的风险行为，并提高对心理社会和精神药理学治疗的依从性。它由三个主要部分组成：a）患者住院期间的三次单独会议，B）与患者及其父母/监护人在医院的一次面对面会议，以及c）出院后六个月内与患者及其父母/监护人的一系列预定电话联系。CLASP-A基于风险降低模型，具体针对四个通用和潜在可改变的风险因素：绝望，家庭支持受损，解决问题的缺陷和治疗不依从性。该提案的总体目标是进一步发展CLASP-A干预措施，以满足青少年的需求，并研究该干预方案在青少年中的可行性和可接受性。我们提出了一个开发阶段，其中包括一个开放试验和迭代修订的治疗手册，试点研究阶段，其中包括一个随机试验（n=50），和修订阶段。根据我们的研究结果，我们将修改CLASP-A，目的是创建一个灵活的协议，其中重点可以根据患者/家庭的当前问题转移，并可以选择策略来适应患者的发展阶段。这项试点研究的结果将为一项更大规模的临床试验奠定基础，该临床试验将评估这种新的预防性干预措施，用于在从住院治疗过渡到门诊治疗的高风险期间，对这一高风险患者群体的自杀行为进行干预。 公共卫生相关性：青少年自杀是一个日益严重的公共卫生问题。然而，相对较少的研究致力于开发或测试直接针对自杀行为的干预措施。这项治疗发展补助金的目标是为有自杀企图的青少年制定一项预防性干预措施。

DESCRIPTION (provided by applicant): Suicide is the third leading cause of death in the 15-24 age group and accounts for more deaths than all natural causes combined. In 2007, 14.5% of U.S. high school students seriously considered suicide, 6.9% reported making at least one suicide attempt in the previous twelve months, and 2% of students reported making at least one suicide attempt in the previous twelve months that required medical attention. Despite the high public health significance of suicide and suicide attempts, there has been relatively little research devoted to developing or testing interventions that directly target suicidal behavior. There is no gold standard treatment for adolescent suicidality; reviews of published randomized controlled trials for adolescent suicidality conclude that treatments to date have been minimally efficacious. Thus, the consideration of new multi-modal interventions that can be applied to suicidal adolescents during the high risk transition period from inpatient to outpatient care, irrespective of diagnosis, is clearly warranted. The purpose of this R34 treatment development grant is to develop the "Coping Long-term with Attempted Suicide Program - Adolescents (CLASP-A)," an integrated, adjunctive intervention program for adolescents who have made a previous suicide attempt. The goals of CLASP-A are to reduce continued suicidal behavior and ideation, reduce risk behaviors for suicide, and improve adherence to psychosocial and psychopharmacologic treatments. It 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 parent/guardian in the hospital and c) a series of scheduled telephone contacts with the patient and parent/guardian for six months following discharge from the hospital. CLASP-A is based on a risk reduction model, and specifically targets four generic and potentially modifiable risk factors: hopelessness, impaired family support, problem solving deficits, and treatment non-adherence. The overall aim of this proposal is to further develop the CLASP-A intervention to address the needs of adolescents and to examine the feasibility and acceptability of this intervention program in adolescents. We propose a development phase which includes an open trial and iterative revisions to the treatment manual, a pilot study phase which includes a randomized trial (n=50), and a revision phase. Based on our findings, we will revise CLASP-A, with the objective of creating a flexible protocol in which emphasis can be shifted based on the presenting problems of the patient/family, and strategies can be selected to accommodate the developmental stage of the patient. The results from this pilot study will lay the groundwork for a larger clinical trial evaluating this new adjunctive intervention for suicidality for this high risk group of patients during the high risk period of transition from inpatient to outpatient care. PUBLIC HEALTH RELEVANCE: Adolescent suicidality is a growing public health concern. However, relatively little research has been devoted to developing or testing interventions that directly target suicidal behavior. The goal of this treatment development grant is to develop an adjunctive intervention for adolescents who have made a suicide attempt.