Suicide Prevention Among Substance Abusing Homeless Youth

 描述(由申请人提供)：虽然关于无家可归青年的研究正在增加，但关于对这些青年的有效干预的信息缺乏。这一点非常令人担忧，因为研究表明，70-95%的人报告有酗酒或吸毒的问题，66%的无家可归青年有心理健康障碍(Cauce等人，2004年)。自杀是主要的死亡原因，高达68%的年轻人报告了终生自杀未遂(Rotheram-Borus&Milburn，2004；Yoder，Whitbeck，&Hoyt，2010)。在那些尝试过的人中，报告的平均尝试次数为6.2次。此外，终生自杀意念率从14%到66.5%不等(Kingree等人，2001年；Merscham等人，2010年；Yoder，Whitbeck和Hoyt，2010年)。已经确定了无家可归青年中自杀的一些预测因素。这些包括药物使用、童年身体和性虐待、流落街头时的受害经历以及心理功能，包括抑郁、绝望、耐受痛苦、冲动控制、社会支持和解决问题。本研究使用一般认知理论(Beck，1967)，辅以两个特定自杀理论模型的概念，来指导我们的干预和概念转变模型。与试点R34声明一致，这项研究的目标是试点测试一种先前已经在青少年自杀未遂者中证明了可行性和前景的干预措施(Brent等人，2009年；Stanley等人，2009年)，以及对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)。150名最近有严重自杀意念的无家可归青年将被随机分配到实验性认知疗法+照常服务(SAU)(n=75)或单独SAU(n=75)。SAU包括那些通常通过本地投放中心提供的服务。后续评估将在基线后3个月、6个月和9个月进行。据推测，与单独接受SAU相比，接受CTSP+SAU的年轻人随着时间的推移将显示出更大的自杀意念(主要结果)、物质使用和抑郁症状(次要结果)的减少。此外，将对理论上派生的调解人进行测试，以阐明与变化相关的机制。这项研究的数据将被用来确定这一有希望的干预措施的初步效果，并确定研究结果是否值得进行更广泛的有效性试验。归根结底，注重减少这些青年中的自杀风险，有可能减少青年这一高危人群的过早死亡、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.