Pilot Study of Online Interventions for Population-Based Suicide Prevention

基于人群的自杀预防在线干预试点研究

• 批准号: 8354574
• 负责人: URSULA S WHITESIDE
• 金额: $ 36万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-16 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8354574
• 关键词: Accounting; Awareness; Beryllium; Caring; Cause of Death; Clinical; Communities; Computer software; Computerized Medical Record; Data; Diagnosis; Dialectical behavior therapy; Educational Background; Educational process of instructing; Effectiveness; Electronic Mail; Elements; Feedback; Feeling suicidal; Goals; Healthcare; Hospitalization; Human Resources; Individual; Intervention; Letters; Link; Literature; Maintenance; Medical Records; Mental Depression; Mental Health; Methods; Modeling; Outpatients; Participant; Patients; Persons; Phase; Pilot Projects; Population; Prevention; Prevention program; Preventive Intervention; Primary Health Care; Primary Prevention; Psychological reinforcement; Psychotherapy; Questionnaires; Randomized; Research; Research Design; Resources; Risk; Safety; Sampling; Screening procedure; Secondary Prevention; Secure; Self-Injurious Behavior; Services; Suicide; Suicide attempt; Suicide prevention; Surveys; System; Telephone; Testing; Time; United States; Visit; Work; active method; base; contingency management; cost; design; effective intervention; effectiveness trial; high risk; indicated prevention; injury prevention; intervention program; outreach; pilot trial; population based; programs; public health priorities; randomized trial; response; safety testing; skills; suicidal morbidity; suicide rate; tertiary prevention; tool; treatment as usual

DESCRIPTION (provided by applicant): Reducing the risk of suicide attempt and suicide is a public health priority. In the United States, 36,000 people die annually from suicide and it is our nation's 10th leading cause of death. There has been no substantial decrease in suicide for the past two decades. Prevention efforts to date have focused on primary (e.g. public service announcements) and tertiary (e.g. interventions following suicide attempt) methods. Secondary or indicated prevention has been relatively unexplored. Secondary prevention requires both accurate screening methods and effective interventions. These essential elements are now available. Our recent research demonstrates that responses to the suicidal ideation item of the PHQ depression scale are a powerful predictor of subsequent suicide attempt and death. Availability of the PHQ in electronic medical records creates an opportunity for accurate population-level screening. Dialectical behavior therapy (DBT) has strong evidence of tertiary efficacy for preventing suicide attempts in clinical populations. Brief outreach tertiary interventions such as caring messages have some evidence for preventing suicide attempts. These clinical or tertiary prevention interventions provide the best available evidence for use in building secondary prevention programs. Resulting programs could then be linked to population-level screening data in electronic medical records. The first goal of the research plan is to adapt DBT and caring messages to fit delivery models suitable for the large numbers of at-risk patients identifiable in healthcare settings. The second goal is to evaluate the feasibility, acceptability, and safety of these alternative online suicide and self-injury secondary prevention programs. Online delivery models are suitable because they are scalable and can be provided securely, cheaply, and utilizing existing systems in healthcare. Three brief online interventions will be evaluated: caring email (CE); CE + DBT online program; and CE + DBT online program + coach. Each intervention will supplement usual care among high- risk patients identified via PHQ depression scales collected at outpatient primary care and mental health visits. Intervention content will be drawn from the principles of DBT and caring messages. The study design will be additive in order to examine alternative intervention models that vary widely in resources required for large- scale delivery. However, these interventions will require vastly fewer resources than in-person or telephone interventions. The project will involve intervention feasibility (pretesting, N=60) and acceptability and safety testing (pilot, N=400). Acceptability wll be assessed by patient intervention engagement levels (requiring the large pilot sample) and qualitative/formative intervention feedback from patients. Safety will be assessed via rates of psychiatric hospitalizations and self-injury diagnoses in the medical record in the intervention conditions compared to those receiving just continued usual care. Results of the pilot study will inform the design of a full-scale effectiveness trial examining the impact of one or more of these interventions on risk of suicide attempt and/or suicide death. PUBLIC HEALTH RELEVANCE: Pilot study of Online Interventions for Population-Based Suicide Prevention PROJECT NARRATIVE th In the United States, 36,000 people die annually from suicide and it is our nation's 10 leading cause of death. Suicide prevention is a national priority and yet secondary prevention programs targeting those most at risk are lacking. The purpose of the current research is to develop and pilot test three promising suicide prevention programs that, if found acceptable to high-risk individuals, could be further evaluated and eventually offered broadly and affordably to the public.

描述(由申请人提供)：降低自杀未遂和自杀的风险是公共卫生的优先事项。在美国，每年有3.6万人死于自杀，这是我们的 全国第十大死因。在过去的二十年里，自杀率并没有大幅下降。到目前为止，预防工作的重点是初级方法(如公共服务公告)和第三方法(如自杀未遂后的干预)。二级或有针对性的预防相对来说还没有被探索过。二级预防需要准确的筛查方法和有效的干预措施。这些基本要素现在都可用了。我们最近的研究表明，对PHQ抑郁量表中自杀意念项目的反应是随后自杀企图和死亡的有力预测因素。PHQ在电子病历中的可获得性为准确的人群水平筛查创造了机会。辩证行为疗法(DBT)有强有力的证据表明，在临床人群中预防自杀企图具有三级疗效。简短的外展第三级干预措施，如关怀信息，有一些证据可以防止自杀企图。这些临床或三级预防干预措施为建立二级预防方案提供了最好的可用证据。然后，产生的程序可以与电子医疗记录中的人口水平筛查数据相联系。研究计划的第一个目标是适应 DBT和关怀信息，以适应适合于医疗保健环境中可识别的大量高危患者的交付模式。第二个目标是评估这些替代在线自杀和自我伤害二级预防计划的可行性、可接受性和安全性。在线交付模式是合适的，因为它们是可扩展的，并且可以安全、廉价地提供，并且可以利用医疗保健中的现有系统。将评估三种简短的在线干预措施：关怀电子邮件(CE)；CE+DBT在线计划；CE+DBT在线计划+Coach。每项干预措施都将补充通过在门诊、初级保健和精神健康访问中收集的PHQ抑郁量表确定的高危患者的常规护理。干预内容将从DBT的原则和关爱信息中提取。研究设计将是附加的，以检查替代干预模式，这些模式在大规模交付所需的资源方面差别很大。然而，与面对面或电话干预相比，这些干预需要的资源要少得多。该项目将涉及干预可行性(预试，N=60)和可接受性和安全性测试(试行，N=400)。可接受性将通过患者干预参与度(需要大的试点样本)和患者的定性/形成性干预反馈来评估。安全性将通过在干预条件下的医疗记录中的精神住院率和自伤诊断率来评估，而不是仅仅接受常规护理的患者。试点研究的结果将为设计一项全面的有效性试验提供参考，该试验旨在审查一种或多种干预措施对自杀未遂和/或自杀死亡风险的影响。 公共卫生相关性：基于人口的自杀预防项目在线干预的试点研究在美国，每年有3.6万人死于自杀，这是我们国家的10大主要死因。自杀预防是国家的优先事项，但缺乏针对风险最高的人的二级预防计划。目前这项研究的目的是开发和试点三个有希望的自杀预防计划，如果发现高危个人可以接受，就可以进一步评估，最终向公众提供广泛和负担得起的服务。