Suicide Prevention Among Substance Abusing Homeless Youth

 描述（由申请人提供）：虽然对无家可归的青年的研究正在增加，但缺乏有关对这些青年进行有效干预的信息。这是一个重大问题，因为研究表明，70-95%的人报告有问题的酒精或毒品使用，66%至89%的无家可归的青年有心理健康障碍（Cauce等人，2004年）。自杀是死亡的主要原因，高达68%的年轻人报告一生中有自杀企图（Rotheram-Borus & Milburn，2004; Yoder，Whitbeck，& Hoyt，2010）。据报告，在尝试过的人中，平均有6.2次尝试。此外，终生自杀意念率范围为14%至66.5%（Kingree等人，2001; Merscham等人，2010; Yoder，Whitbeck，& Hoyt，2010）.无家可归青年自杀的一些预测因素已经确定。这些因素包括物质使用、儿童期身体和性虐待、流落街头时的受害经历以及心理功能，包括抑郁、绝望、痛苦容忍、冲动控制、社会支持和解决问题。本研究以一般认知理论（Beck，1967）为基础，辅以两个自杀特定理论模型的概念，以指导我们的干预和概念转变模型。与试点R34公告相一致，本研究的目标是对先前已证明可行性的干预措施进行试点测试，并承诺对青少年自杀者进行干预（布伦特等人，2009; Stanley等人，2009）和低收入成年人样本的有效性，“自杀未遂者的认知疗法干预”（Brown等人，2005年）。将150名近期有严重自杀意念的无家可归青年随机分配到实验性自杀预防认知疗法（CTSP）+常规服务（SAU）组（n=75）或单纯SAU组（n=75）。SAU包括那些通常通过当地的投递中心提供的服务。将在基线后3、6和9个月进行随访评估。据推测，接受CTSP+SAU的青少年与SAU单独治疗相比，随着时间的推移，自杀意念（主要结局）、物质使用和抑郁症状（次要结局）的减少程度更大。此外，理论推导的介质将进行测试，以揭示与变化相关的机制。这项研究的数据将用于确定这种有希望的干预措施的初步疗效，并确定研究结果是否值得进行更广泛的规模有效性试验。最后，对减少这些青年自杀风险的关注有可能减少极高风险青年人口的过早死亡、住院和人力资本损失。

 DESCRIPTION (provided by applicant): While research on homeless youth is increasing, there is a dearth of information regarding effective interventions for these youth. This is of significant concern because studies indicate that 70-95% report problem alcohol or drug use and 66% to 89% of homeless youth have a mental health disorder (Cauce et al., 2004). Suicide is the leading cause of death with up to 68% of youth reporting a lifetime suicide attempt (Rotheram-Borus & Milburn, 2004; Yoder, Whitbeck, & Hoyt, 2010). Among those who have attempted, an average of 6.2 attempts is reported. In addition, lifetime suicide ideation rates have ranged from 14% to 66.5% (Kingree et al., 2001; Merscham et al., 2010; Yoder, Whitbeck, & Hoyt, 2010). Some predictors of suicide among homeless youth have been identified. These include substance use, childhood physical and sexual abuse, victimization experiences while living on the streets, and psychological functioning, including depression, hopelessness, distress tolerance, impulse control, social support, and problem solving. This study uses general cognitive theory (Beck, 1967), complemented with concepts from two suicide specific theoretical models, to guide our intervention and conceptual change model. Consonant with the pilot R34 announcement, this study's goal is to pilot test an intervention that has previously demonstrated feasibility and promise with adolescent suicide attempters (Brent et al., 2009; Stanley et al., 2009) and efficacy with a low-income sample of adults, "The Cognitive Therapy Intervention for Suicide Attempters" (Brown et al., 2005). One-hundred fifty homeless youth with recent severe suicide ideation will be randomly assigned to the experimental cognitive therapy for suicide prevention (CTSP) + services as usual (SAU) (n=75) or to SAU alone (n=75). SAU includes those services normally offered through a local drop-in center. Follow-up assessments will be conducted at 3, 6, and 9-months post-baseline. It is hypothesized that youth receiving CTSP+SAU will show greater reductions in suicide ideation (primary outcome), substance use and depressive symptoms (secondary outcomes) over time compared to SAU alone. Furthermore, theoretically-derived mediators will be tested to shed light on mechanisms associated with change. The data from this study will be used to determine the initial efficacy of this promising intervention, and determine whether findings warrant a broader scale effectiveness trial. Ultimately, attention towards reducing suicide risk among these youth has the potential to reduce premature mortality, hospitalization and loss of human capital in a very high risk population of youth.