Coping Long-Term with Attempted Suicide Program - Adolescents

说明(申请人提供)：自杀是15-24岁年龄组的第三大死因，其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个月中至少有过一次自杀企图，2%的学生报告在之前的12个月中至少有过一次自杀未遂，需要医疗护理。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。青少年自杀没有黄金标准的治疗方法；对已发表的青少年自杀随机对照试验的审查得出结论，到目前为止，治疗是最低限度有效的。因此，在从住院到门诊的高危过渡期间，无论诊断如何，显然有必要考虑可应用于自杀青少年的新的多模式干预措施。这项R34治疗发展赠款的目的是开发“应对长期自杀未遂计划--青少年(CLASP-A)”，这是一项针对有过自杀未遂经历的青少年的综合辅助干预计划。CLAP-A的目标是减少持续的自杀行为和意念，减少自杀的危险行为，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)病人在医院期间的三次单独会面；b)在医院与病人及其父母/监护人进行一次面对面的会面；以及c)出院后六个月内与病人及其父母/监护人进行一系列预定的电话联系。CLAP-A基于风险降低模型，专门针对四个一般的和潜在的可修改的风险因素：绝望、家庭支持受损、解决问题的缺陷和治疗不依从。这项建议的总体目标是进一步发展CLAP-A干预措施，以满足青少年的需要，并审查这一干预计划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，包括开放试验和对治疗手册的迭代修订，初步研究阶段，包括随机试验(n=50)，以及修订阶段。根据我们的发现，我们将修订CLAP-A，目的是创建一种灵活的方案，其中重点可以根据患者/家庭的表现问题进行转移，并可以选择策略以适应患者的发育阶段。这项初步研究的结果将为一项更大规模的临床试验奠定基础，评估这种新的辅助干预措施在从住院到门诊护理的高风险时期对这类高危患者的自杀行为。

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.