Online Screening and Early Intervention to Prevent Suicide among Middle-Aged Men

 描述（由申请人提供）：自杀是中年男性（35-64岁）死亡的主要原因，也是密歇根州（研究所在州）该年龄组男性受伤死亡的主要原因。依靠传统的心理健康服务来接触和吸引这个年龄段的男性并没有导致自杀问题的认识或寻求帮助的行为增加。虽然存在有效的自杀治疗方法，但治疗不能帮助那些不认为自己有问题的人，因此看不到帮助。该领域缺乏有效和高效的计划和干预措施，积极参与中年男性的循证干预措施，以增加自杀问题的识别和寻求帮助的行为。我们将研究专门为35-64岁男性设计的全面在线筛查和转诊干预的有效性。主要结果包括自杀行为（自杀企图和准备行为），自杀意念和抑郁。次要结果包括：对求助的态度和求助行为;自杀风险因素（即，酗酒、关系冲突、经济问题和人际关系需要7）;以及 社会支持的保护因素。在抑郁症筛查中得分处于抑郁症中度至高度风险范围内的男性，或在自杀筛查中得分为自杀意念和/或行为的男性，将被要求参加本研究。参与者将被随机分配到两组中的一组：心理健康筛查;或心理健康筛查，加上男性治疗。男性治疗是专门为那些有自杀风险和不太可能从事寻求帮助行为的男性设计的。一系列的数据分析技术将被用来评估人的治疗的累加效应。核心分析将是一项纵向混合模型路径分析，用于检验主要和次要结局的组间和组内差异。模型设计还将包括间接影响（中介和缓和）的估计。将在基线时收集抑郁、自杀行为和意念的主要结局数据，然后在随机分配至研究组后2周和12周再次收集。次要结局将在随机分配至研究组后2周和12周测量。使用序贯混合方法研究设计，研究人员将对两个研究组的男性进行有目的的子样本访谈，以进一步评估和比较男性寻求自杀预防服务的障碍和促进因素。这项创新的研究，可以广泛适用于全国其他州，可能会促进中年男性的自杀预防，这是一个自杀的高危人群，他们往往很难进行自杀问题识别和寻求帮助的行为。

 DESCRIPTION (provided by applicant): Suicide, a primary cause of death among middle-aged men (35-64 years old), is the leading cause of injury death among men in this age group in Michigan (state where study takes place). Reliance on traditional mental health services to reach out to and engage men in this age group has not resulted in increased suicide problem recognition or help-seeking behavior. While effective treatment for suicide exists, treatment cannot help men who don't identify as having a problem, and therefore don't see help. The field lacks effective and efficient programs and interventions that actively engage middle-aged men in evidence-based interventions to increase suicide problem identification and help-seeking behavior. We will examine the effectiveness of a comprehensive online screening and referral intervention, specifically designed for men ages 35-64. Primary outcomes include suicide behavior (suicide attempts and preparatory acts), suicide ideation and depression. Secondary outcomes include: attitudes toward help-seeking and help-seeking behavior; suicide risk factors (i.e., alcohol abuse, relationship conflicts, financial problems and interpersonal needs7); and the protective factor of social support. Men who score in the moderate-to-high risk range for depression on the depression screen, or any score for suicide ideation and/or behavior on the suicide screen, will be asked to participate in the study. Participants will be randomly assigned to one of two groups: Screening for Mental Health; or Screening for Mental Health, plus Man Therapy. Man Therapy is specifically designed for men who are at risk for suicide and less likely to engage in help-seeking behavior. A series of data analysis techniques will be used to evaluate the additive effect of Man Therapy. The core analysis will be a longitudinal mixed-model path analysis testing for between-group and within-group differences on primary and secondary outcomes. The model design will also include estimations of indirect effects (mediation and moderation). Data will be collected on primary outcomes of depression and suicidal behavior and ideation at baseline and then again at 2- and 12-weeks post randomization to study arm. Secondary outcomes will be measured 2- and 12-weeks post randomization to study arm. Using a sequential mixed-methods research design, researchers will interview a purposive sub-sample of men referred to both study arms to further assess and compare barriers and facilitators to men seeking suicide prevention services. This innovative study, which can be widely applicable to other states across the country, may advance suicide prevention among middle-aged men, a high-risk group for suicide who tend to be difficult to engage in suicide problem identification and help-seeking behavior.