1/2 Brief Intervention for Suicide Risk Reduction in High Risk Adolescents

1/2 降低高危青少年自杀风险的简短干预措施

• 批准号: 8796231
• 负责人: David A. Brent
• 金额: $ 23.1万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-02-01 至 2016-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8796231
• 关键词: Address; Adherence; Adolescent; Adult; Affect; Aftercare; Alcohol or Other Drugs use; Ambulatory Care; Behavior; Body Weight; Cause of Death; Clinic; Clinical; Collaborations; Communities; Competence; Continuity of Patient Care; Data; Development; Diagnosis; Diagnostic; Disease; Dose; Effectiveness; Ensure; Event; Family; Feeling suicidal; Goals; Habits; Health; Health Services Accessibility; Home environment; Home visitation; Hospitals; Hour; House Call; Improve Access; Informal Social Control; Inpatients; Institutes; Intervention; Interview; Lead; Manic; Manuals; Measures; Medical center; Motivation; National Institute of Mental Health; Online Systems; Outcome; Outpatients; Parents; Participant; Patients; Phase; Play; Procedures; Provider; Psychopathology; Randomized; Randomized Clinical Trials; Recommendation; Recurrence; Resources; Risk; Risk Reduction; Role; Safety; Sampling; Schedule; Site; Sleep; Social support; Structure; Suicide; Suicide attempt; Suicide prevention; Target Populations; Techniques; Teenagers; Telephone; Texas; Therapeutic; Time; Universities; Work; Youth; accomplished suicide; age group; aged; brief intervention; clinical risk; coping; cost effective; flexibility; follow-up; high risk; improved; innovation; mortality; motivational enhancement therapy; novel; performance site; person centered; positive mood; prevent; satisfaction; sobriety; suicidal; suicidal adolescent; suicidal behavior; suicidal patient; suicidal risk; therapy adherence; therapy development; usability

DESCRIPTION (provided by applicant): We propose a 2-site R34 to develop a brief, flexible, manualized intervention with supporting phone app to reduce the risk of suicidal behavior in adolescents with high suicidal ideation or a recent suicide attempt, during the transition from inpatient to outpatient care. This transition period is the highest risk period for attempted and completed suicide. Suicide is the 3rd leading cause of adolescent mortality, and there are currently no established interventions for suicidal teens. By developing a treatment that can be delivered on an inpatient unit prior to the transition to outpatient treatment, we anticipate being able to lower suicidal risk and increase the likelihood that participants will attend subsequent outpatient treatment. In keeping with the priorities of NIMH, this intervention aimed at reducing the risk of suicide and suicidal behavior will be trans-diagnostic. We term the intervention ASAP, with anticipated components: (1) Adherence- promoting engagement and adherence to treatment through motivational interviewing; (2) Safety planning; and (3) Affect Protection- selecting from a menu of techniques for maintaining positive affect (e.g. savoring and switching strategies, mobilizing social support, maintaining sobriety, and improving sleep). Each of these components will be delivered within a Motivational Interviewing framework for enhancing intrinsic motivation for change. Treatment is brief (6-8 hours), and flexibly delivered on inpatien units or in home visits prior to initiation of outpatient treatment. ASAP augments protective factors against recurrent suicidal behavior and includes the family in the treatment. A safety plan phone app to extend the impact of treatment will also be developed. Innovative features include: (1) delivery of an intervention at a time and place when suicidal risk is highest; (2) augmentation of protective factors against recurrent suicidal behavior, specifically by promoting development of positive affect, healthy sleep and social support; (3) a Safety plan phone app to extend the impact of treatment; and (4) liaison with the outpatient therapist to ensure continuity of care. Th specific aims are 5 treatment development phases: (1) Open semi-structured interviews with 5 suicidal teens and parents and 5 clinicians at each site on the proposed content and context of the proposed treatment; (2) Develop the ASAP modules, adherence/competence measures, and phone app, and repeat open interviews; (3) Open trial of ASAP in 10 adolescents (5 at each site); (4) Debrief patients and families, inpatient and outpatient providers, examine the impact of treatment on proximal indicators of suicidal risk, and revise accordingly; (5) Conduct an RCT of ASAP followed by Aftercare (AC) vs. AC alone in 80 suicidal teens (across both sites) to determine ASAP's feasibility, acceptability, impact on proximal targets (e.g., adherence to outpatient care, sleep, positive affect, substance use), suicidal ideation and behavior. ASAP, developed with and intended for community clinicians, has the potential to be a sustainable intervention to reduce the burden of adolescent suicidality.

描述（由申请人提供）：我们提出了一个2个站点R34，以支持手机应用程序进行简短，灵活，手动的干预措施，以减少自杀质量高的青少年自杀行为的风险，或者在从患病患者到门诊护理过渡到门诊期间的过渡期间。这个过渡期是未遂和完成自杀的最高风险期。自杀是青少年死亡率的第三主要原因，目前尚无自杀青少年的既定干预措施。通过开发可以在过渡到门诊治疗之前可以在住院单元上交付的治疗方法，我们预计将是 能够降低自杀风险并增加参与者参加随后的门诊治疗的可能性。为了符合NIMH的优先事项，这种旨在降低自杀和自杀行为风险的干预措施将是反诊断的。我们尽快将干预措施评为预期组成部分：（1）通过动机访谈依从性促进参与和遵守治疗； （2）安全计划； （3）影响保护 - 从一份菜单中选择以保持积极影响（例如，品尝和切换策略，动员社会支持，保持清醒和改善睡眠）。这些组件中的每一个都将在激励性的访谈框架内交付，以增强内在的变革动机。治疗是短暂的（6-8小时），并在开始门诊治疗之前灵活地在室内单位或家庭访问中进行。尽快增加防止反复自杀行为的保护因素，并将家庭包括在治疗中。安全计划 还将开发电话应用程序以扩展治疗的影响。创新功能包括：（1）自杀风险最高时，一次和地点进行干预； （2）增强 防止反复自杀行为的保护因素，特别是通过促进积极影响，健康睡眠和社会支持的发展； （3）安全计划手机应用程序，以扩大治疗的影响； （4）与门诊治疗师联络以确保护理的连续性。具体目的是5个治疗发展阶段：（1）在每个地点对5名自杀青少年和父母的公开半结构化访谈，以及5位临床医生在拟议治疗的拟议内容和背景下进行公开的访谈； （2）开发ASAP模块，依从性/能力措施和电话应用程序，并重复开放访谈； （3）在10名青少年中对ASAP的开放试验（每个地点为5个）； （4）汇报患者和家庭，住院和门诊提供者，检查 以自杀风险的近端指标进行治疗，并进行相应的修订； （5）进行ASAP的RCT，然后在80个自杀青少年（跨两个地点）中单独进行后期（AC）与AC进行AC，以确定ASAP的可行性，可接受性，对近端目标的影响（例如，遵守门诊护理，睡眠，睡眠，积极影响，阳性影响，使用物质），自杀式和行为。与社区临床医生开发和打算的ASAP有可能成为可持续的干预措施，以减轻青少年自杀的负担。