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Peer mentorship to reduce suicide risk following psychiatric hospitalization

同伴辅导可降低精神病住院后的自杀风险

基本信息

批准号：
8678081
负责人：
Paul Nelson Pfeiffer
金额：
$ 19.44万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-07-15 至 2017-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8678081
关键词：
Accident and Emergency department Admission activity Adult Age American Blinded Caring Cause of Death Centers for Disease Control and Prevention (U.S.)Certification Communities Distress Documentation Effectiveness of Interventions Enrollment Ensure Exclusion Criteria Feeling hopeless Feeling suicidal Freedom Future Goals Health Health Care Costs Health system Hospitalization Impaired cognition Individual Inpatients Institutes Intervention Manuals Measures Mediator of activation protein Medical Records Mental Depression Mental Health Mental Health Services Mental disorders Mentors Mentorship Michigan Monitor Participant Patients Persons Pilot Projects Play Population Preparation Prevention Prevention strategy Preventive Intervention Productivity Protocols documentation Provider Psyche structure Psychiatric Hospitals Psychiatry Psychotherapy Quality of life Randomized Randomized Controlled Trials Recovery Recruitment Activity Research Research Priority Risk Risk Factors Risk Management Role Rural Safety Services Social isolation Social support Specialist Suicide Suicide attempt Suicide prevention Surgeon System Telephone Testing Time Training Training Programs Training Support United States United States National Institutes of Health United States Substance Abuse and Mental Health Services Administration Universities Visit Work arm base cost depressive symptoms disability disorder prevention effective intervention efficacy trial eligible participant evidence base experience follow-up health care delivery high risk holistic approach hospital readmission improved inclusion criteria innovation middle age novel novel strategies patient population peer prevent primary outcome public health relevance reducing suicide resilience secondary outcome severe mental illness suicidal behavior suicidal morbidity suicidal risk suicide rate theories treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Suicide is a leading cause of death and suicide attempts are a major cause of disability, lost productivity, and health care costs. Suicide prevention is a research priority of the National Institutes of Health, and the US Surgeon General's National Strategy for Suicide Prevention calls for a shift towards recovery-oriented prevention efforts which promote hope and social support. Hopelessness and social isolation are two proximal risk factors for suicide which may be improved via peer mentorship, a form of peer support effective for preventing depression and repeat psychiatric hospitalizations. The primary aims of this study are to develop and pilot test a peer mentorship intervention for psychiatrically hospitalized patients at high risk for suicide. The intervention will be adapted by an expert panel from existing peer support training protocols to target suicide risk factors and to enhance suicide risk management. Protocols for training and supervising peer mentors and measures of intervention fidelity will also be developed. The intervention will then be pilot teste among 60 participants randomly assigned to receive the peer mentorship intervention plus usual care or usual care alone. Participants will be recruited from the inpatient psychiatry unit at the University of Michigan Health System. Inclusion criteria will include medical record documentation of suicidal ideation or suicide attempt at admission, and exclusion criteria will include significant cognitive impairment (according to the Mini-Cog), current receipt of peer support, or determination that peer mentorship may cause distress to the patient or the peer mentor. The peer mentorship intervention will include an in-person visit on the inpatient unit and regular in-person or telephone follow-up for 3 months post-discharge. The intervention will be delivered by peer specialists--individuals in stable recovery from serious mental illness who have received formal training and certification in peer support from the state of Michigan--with at least 6 months of professional peer support experience. The primary outcomes of the pilot study are acceptability and feasibility of the intervention as determined by: 1) >50% of eligible participants enroll in the study, 2) >70% of enrollees complete final follow- up measures at 6 months, and 3) among those assigned to the peer mentorship intervention, >80% complete an inpatient session and the median number of total sessions is at least 4. Peer mentorship sessions will be recorded and rated for fidelity. Measures of suicidal ideation and suicide attempts (the intended primary outcomes of a subsequent efficacy study) and secondary outcomes such as quality of life, functioning, depression, and service use will be obtained at baseline, 3 months, and 6 months post-enrollment by a research assistant blinded to study arm. An exploratory aim will be to measure potential mediators of intervention effectiveness including belongingness, burdensomeness, and hopelessness according to the interpersonal theory of suicide. If acceptability and feasibility are demonstrated, the study will result in a novel recovey-oriented suicide prevention intervention ready for a fully-powered randomized controlled efficacy trial.

描述（由申请人提供）：自杀是死亡的主要原因，而自杀企图是导致残疾、生产力损失和医疗保健费用的主要原因。预防自杀是美国国立卫生研究院的研究重点，美国卫生局局长的国家自杀预防战略呼吁转向以恢复为导向的预防工作，以促进希望和社会支持。绝望和社会孤立是自杀的两个最接近的危险因素，可以通过同伴指导来改善，同伴指导是一种有效预防抑郁和重复精神病住院的同伴支持形式。这项研究的主要目的是为自杀高危的精神病住院患者开发并试点测试同伴指导干预措施。干预措施将根据现有同伴支持培训方案中的专家小组，旨在针对自杀风险因素并加强自杀风险管理。还将制定培训和监督同伴导师的协议以及干预忠诚度的措施。然后，干预措施将在 60 名参与者中进行试点测试，随机分配接受同伴指导干预加常规护理或仅接受常规护理。参与者将从密歇根大学卫生系统住院精神病科招募。纳入标准将包括入院时自杀意念或自杀企图的医疗记录文件，排除标准将包括严重的认知障碍（根据 Mini-Cog）、当前接受的同伴支持或确定同伴指导可能会给患者或同伴指导者带来痛苦。同伴指导干预将包括对住院部的亲自访问以及出院后 3 个月的定期亲自或电话随访。干预措施将由同伴专家进行，这些专家是从严重精神疾病中稳定康复的个人，接受过密歇根州同伴支持的正式培训和认证。至少 6 个月的专业同伴支持经验。试点研究的主要结果是干预措施的可接受性和可行性，具体取决于：1) >50% 的合格参与者参加了研究，2) >70% 的参与者在 6 个月时完成了最终随访措施，3) 在分配给同伴指导干预的参与者中，>80% 完成了住院治疗，总治疗次数中位数至少为 4。将记录同伴指导会议并获得保真度评级。对自杀意念和自杀企图（后续功效研究的预期主要结果）和次要结果（例如生活质量、功能、抑郁和服务使用）的测量将由对研究组不知情的研究助理在基线、入组后 3 个月和 6 个月获得。一个探索性的目标是根据自杀的人际理论来衡量干预效果的潜在中介因素，包括归属感、负担感和绝望感。如果可接受性和可行性得到证实，该研究将产生一种新型的以康复为导向的自杀预防干预措施，为全面的随机对照疗效试验做好准备。