Mobile Phone Intervention to Prevent Youth Suicide in Rural Communities

十多年来，减少青少年自杀一直被列为国家优先事项，但青少年自杀率和自杀未遂率并没有下降。自杀仍然是10 - 24岁人群的第三大死因，农村社区的自杀率是全国平均水平的两倍多。由于青少年与成年人之间的沟通极少，青少年寻求的帮助极少，以及精神卫生服务的可获得性和可接受性问题，守门人培训等普遍采用的战略对公共卫生的影响有限。这些障碍尤其重要 在农村和服务不足的社区，青年自杀率高出2-10倍，现有服务的利用率较低。以学校为基础、面向人口的战略克服了其中的一些限制，但现有的方案尚未利用移动的通信设备直接向青少年提供预防干预措施，甚至超出学校范围。短信是改变健康行为的低成本、有效工具，正在成为影响青少年危险行为的有力公共卫生工具。我的应用程序将是移动的设备在基于人群的自杀预防中的第一个扩展。K23职业发展奖将为我提供所需的教育和经验，使我成为一名独立调查员，专注于开发和测试以移动为媒介的公共卫生干预措施，以减少青少年自杀。该提案有三个职业发展目标：目标1。干预发展。学习开发安全，参与和有效的移动介导的心理健康干预所需的原则和实践，以针对青少年的自杀风险和保护过程。目标2.预防试验设计。获得专业知识和合作者，以选择和排序预防试验设计和研究方法，适合于测试灵活的电子提供的干预措施，为青年。Gol 3.健康知识。获得科学和技术知识，与技术专家进行有效合作，并评估移动健康技术在预防青少年自杀方面的机会。我开发了一个研究项目，为满足这些职业发展目标提供了一个框架。我的研究目标是开发和测试通过移动的技术提供给青少年的自杀预防干预的效果。为了实现这个目标，我的项目有三个目标：目标1。发展开发一种安全和吸引人的短信干预（Text 4Strength），以加强青少年的情绪自我调节技能和资源。目标2.现场测试。通过对43名青少年进行实地测试，评估Text 4Strength的使用情况、可用性、参与者感知和系统操作，并根据需要修改干预措施。目标3。试点RCT。评估Text 4Strength的承诺。评估Text 4Strength对关键近目标的影响：监控情绪的技能，减少升级，以及使用成人关系资源来保持情绪平衡。其次，我将探讨干预对心理困扰，抑郁症状，焦虑症状和自杀意念的影响。由这个研究项目锚定的职业发展计划将给我的技能，经验，合作者和技术基础设施，我需要在应用移动的技术，以防止青少年自杀在农村社区的领先专家。通过将选择丰富的干预措施交给农村地区的年轻人， 在社区中，拟议的研究解决了NIMH的优先事项：战略目标3，以改善和个性化的心理健康干预措施;战略4.1，以测试新的模式和方法，使心理健康干预措施，以不同的群体，包括农村社区。

DESCRIPTION (provided by applicant): Reducing youth suicide has been named as a national priority for more than a decade, yet rates of youth suicide and suicide attempts have not declined. Suicide is still the 3rd leading cause of death for ages 10 - 24, and suicide rates i rural communities are more than double the national average. The public health impact of commonly applied strategies, such as gatekeeper training, is limited by minimal communication between adolescents and adults, minimal help seeking by adolescents, and by problems with accessibility and acceptability of mental health services. These barriers are particularly relevant in rural and underserved communities, which have 2-10 times higher youth suicide rates and lower utilization of available services. School-based, population oriented strategies overcome some of these limitations, but existing programs have yet to harness mobile communication devices to reach adolescents with preventive interventions directly, even beyond the school context. Text messaging is low-cost, effective tool for changing health behaviors, and is emerging as a powerful public health tool for influencing adolescent risk behavior. My application would be the first extension of mobile devices into population-based suicide prevention. The K23 career development award will provide me with the education and experience I need to become an independent investigator focused on developing and testing mobile-mediated public health interventions to reduce youth suicide. This proposal has three career development goals: Goal 1. Intervention Development. Learn the principles and practices needed to develop a safe, engaging, and effective mobile-mediated mental health intervention to target suicide risk and protective processes for youth. Goal 2. Prevention Trial Design. Gain expertise and collaborators to select and sequence prevention trial designs and research methods that are suitable for testing flexible electronically-delivered interventions for youth. Gol 3. mHealth Knowledge. Gain scientific and technical knowledge to collaborate effectively with technical experts and to assess opportunities for mHealth technologies in youth suicide prevention. I developed a research project that provides a framework for meeting these career development goals. My research objective is to develop and test the effects of a suicide preventive intervention delivered to adolescents via mobile technology. To achieve this objective my project has three aims: Aim 1. Development. Develop a safe and engaging text messaging intervention (Text4Strength) to strengthen adolescent's emotion self-regulation skills and resources. Aim 2. Field Testing. Assess the usage, usability, participant perceptions, and system operation of Text4Strength by conducting a field test of with 43 adolescents, and revise the intervention as needed. Aim 3. Pilot RCT. Assess the promise of Text4Strength. Assess the impact of Text4Strength on key proximate targets examining: skills in monitoring emotions, reducing escalation, and using adult relational resources to maintain emotional equilibrium. Secondarily, I will explore the intervention's impact on psychological distress, depressive symptoms, anxiety symptoms, and suicide ideation. The career development plan anchored by this research project will give me the skills, experiences, collaborators, and technical infrastructure that I need to be a leading expert in applying mobile technology to prevent youth suicide in rural communities. By putting an option-rich intervention in the hands of youth in rural communities, the proposed research addresses NIMH priorities: Strategic Objective 3 to improve and personalize mental health interventions; Strategy 4.1 to test novel models and methods to bring mental health interventions to diverse groups, including rural communities.