Tailored Activation in Primary Care to Reduce Suicide Behaviors in Middle Aged Men

初级保健中的定制激活以减少中年男性的自杀行为

• 批准号: 9029936
• 负责人: PAUL R DUBERSTEIN
• 金额: $ 33万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9029936
• 关键词: Tailored; Activation; Primary; Care; Reduce

 DESCRIPTION (provided by applicant): Nearly all efforts to reduce suicide behaviors in men aged 35-64 (heretofore middle-aged men) have been targeted to the general population (e.g., means restriction) or to specialty mental health or acute care (e.g., hospital) settings. Yet about half of all middle-aged men who die by suicide are seen by a primary care provider (PCP) within a month of dying, suggesting the value of primary care-based prevention, to complement strategies in other settings. Current impediments to primary care-based prevention are that many suicidal middle-aged men do not visit a PCP, and among those who do the topic of suicide is rarely broached, due to societal gender-linked norms (e.g., toughness); stigma; spurious concerns that talking about suicide increases risk; competing time demands; and lack of resources to cope with positive responses. PCP-targeted educational interventions increase detection of suicidal men, but inconsistently affect suicide behaviors. Suicide behaviors are more likely to be reduced by evidence-based follow-up care (EBFC: supportive follow-up contact and, for depressed patients, collaborative care). However, such care can only be effective if at-risk men visit a PCP who identifies suicide risk and offers the care, and the men accept it. Thus, there is a pressing need to study the effects of activating at risk middle-aged men to signal receptiveness to suicide discussion and care, prompting PCP inquiry and referrals to a form of EBFC that is feasible for most practices to implement. Also pressing is the need for feasible EBFC; uptake is limited, as most practices lack on-site CMs and psychiatrists to offer it. In this proposal, we will enroll middle-aged men with active suicide thoughts in a RCT to examine whether their pre-PCP visit use of the Multimedia Activation to Prevent Suicide (MAPS) for Men tailored interactive computer program, linked with integrated telephone EBFC (TEBFC) (vs. attention control exposure linked with TEBFC), reduces suicide preparatory behaviors (primary outcome, predictive of suicide attempts and deaths) and ideation over 3 months. We will refine MAPS for Men from our research- proven depression activation program, incorporating input we will solicit from a wide array of stakeholders in suicide prevention, guided by empirically-supported behavioral theories.

 描述（由申请人提供）：几乎所有减少35-64岁男性（迄今为止的中年男性）自杀行为的努力都是针对普通人群（例如，意味着限制）或专业精神健康或急性护理（例如，医院）设置。然而， 在所有死于自杀的中年男性中，有一半在死亡后一个月内被初级保健提供者（PCP）看到，这表明了以初级保健为基础的预防的价值，以补充其他环境中的策略。目前基于初级保健的预防的障碍是，许多自杀的中年男子不去看PCP，而在那些去看PCP的人中，由于社会性别相关规范（例如，韧性）;耻辱;虚假的担心，谈论自杀会增加风险;竞争的时间要求;以及缺乏资源来科普积极的反应。以PCP为目标的教育干预增加了自杀男性的检测，但不一致地影响自杀行为。自杀行为更有可能通过循证随访护理（EBFC：支持性随访联系，对于抑郁症患者，合作护理）减少。然而，这种护理只能是有效的，如果在风险的男性访问PCP谁识别自杀风险，并提供照顾，男人acceptedit. Therefore，有迫切需要研究的影响，激活在风险中年男性的信号接受自杀的讨论和照顾，促使PCP查询和转介到一种形式的EBFC，是可行的，大多数做法实施。同样紧迫的是需要可行的EBFC;吸收是有限的，因为大多数做法缺乏现场CM和精神科医生提供它。 在这项建议中，我们将在一项随机对照试验中招募有积极自杀想法的中年男性，以检查他们在PCP前的访视中是否使用了与综合电话EBFC（TEBFC）相关联的多媒体激活以防止男性自杀（MAPS）定制的交互式计算机程序。（相对于与TEBFC相关的注意力控制暴露），减少自杀准备行为（主要结局，预测自杀企图和死亡）和3个月内的意念。我们将从我们的研究证明抑郁症激活计划中完善男性MAPS，纳入我们将从自杀预防的广泛利益相关者那里征求的意见， 行为理论的支持。