Identifying Periods of High Risk and Predictors of Suicide for Youth in Public Child Serving Systems

确定公共儿童服务系统中青少年自杀的高风险期和预测因素

• 批准号: 9766393
• 负责人: JEFFREY A BRIDGE
• 金额: $ 41.5万
• 依托单位: RESEARCH INST NATIONWIDE CHILDREN'S HOSP
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-17 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9766393
• 关键词: Accounting; Address; Adolescent; Adolescent and Young Adult; Advisory Committees; Age; Aging; Agreement; Algorithms; Caring; Cause of Death; Cessation of life; Child; Child Welfare; Communities; County; Data; Data Sources; Databases; Development; Ethnic Origin; Exposure to; Family; Funding; General Population; Geography; Goals; Healthcare; Home environment; Incidence; Individual; Information Systems; Inpatients; Insurance; Intervention; Justice; Life; Link; Longitudinal cohort study; Low income; Measures; Medicaid; Mental Health; Mental disorders; Methods; Modeling; Ohio; Outcome; Outpatients; Population; Prevention program; Problem Solving; Public Health; Race; Research; Research Project Grants; Resources; Risk; Risk Factors; Service setting; Services; Statistical Models; Subgroup; Suicide; Suicide attempt; Suicide prevention; Surgeon; System; Testing; Therapeutic Intervention; Time; United States; Vision; Vital Statistics; Work; Youth; addiction; age group; aged; base; behavioral health; care systems; contextual factors; data sharing; design; experience; foster care; high risk; innovation; insight; intervention program; multidisciplinary; novel; population based; prediction algorithm; programs; prospective; public health relevance; reducing suicide; response; sex; suicidal morbidity; suicidal risk; suicide rate; targeted treatment; tool; young adult

Abstract Suicide is now the second leading cause of death in youth aged 10-24 years, accounting for more deaths in this age group than all those for ten other leading causes of death combined. The vision of the U.S. Surgeon General and the National Action Alliance for Suicide Prevention (Action Alliance) is “a nation free from the tragic experience of suicide.” In pursuit of this vision, the Action Alliance's Research Prioritization Task Force (RPTF) released a research agenda aimed at reducing suicide deaths and suicide attempts 20 percent by 2025. To achieve this ambitious goal, the RPTF has recommended strategically targeting interventions at population subgroups at high risk for suicide in designated “boundaried settings”. Youth in publicly funded systems of care (e.g., Medicaid, child welfare, juvenile justice, and behavioral health) represent an especially large and important “boundaried population” at heightened risk of suicide and mental illness relative to youth in the general population. Unfortunately, despite the large numbers of vulnerable youth in publicly funded programs, little is known about the rates and predictors of suicide for this population. This research project proposes to create, for the first time, an integrated population-based database that links 9 years of data across multiple Ohio child-serving agencies. This is a unique suicide prevention resource currently unmatched by any federal data system. This research has the potential to provide in depth prospective information concerning interactions between dynamic individual and contextual factors that might be fruitfully applied to the development of targeted suicide prevention and intervention programs. Specific aims of this proposed research are three-fold: 1) to quantify the incidence of suicide across and within 4 public child-serving systems in Ohio; 2) to identify high risk periods for suicide among youth in publicly funded sectors; and 3) to develop and validate a risk prediction algorithm to estimate individual risk for suicide in this population. Our central hypothesis is that entry to and exits from child welfare and juvenile justice programs will be associated with increased risk for suicide as will major transitions across levels of mental health care (e.g., moving from inpatient to outpatient). This retrospective longitudinal cohort study will use data on 2.2 million youth in public child serving systems aged 10-24 years who will be followed from 2010 to 2018. We employ a novel multistate statistical modeling approach to test hypotheses about transitions of care (Aim 2) and time-dependent Cox regression to examine predictors of suicide for youth in public child serving systems (Aim 3). The results of this innovative study will identify high-risk transition periods and contribute to a better understanding of risk for suicide among youth in publicly funded systems. Feasibility is supported by an existing commitment from our state partners to provide the linked data necessary to accomplish our objectives.

抽象的 自杀现在是 10-24 岁青少年的第二大死因，在 这个年龄组比其他十个主要死因的所有年龄组的总和还多。美国外科医生的愿景 总则和全国预防自杀行动联盟（行动联盟）是“一个没有自杀倾向的国家” 自杀的悲惨经历。”为了实现这一愿景，行动联盟的研究优先任务组 (RPTF) 发布了一项研究议程，旨在通过以下方式将自杀死亡和自杀企图减少 20%： 2025 年。为了实现这一雄心勃勃的目标，RPTF 建议采取战略性干预措施 在指定的“边界环境”中自杀风险较高的人群亚群。公共资助的青年 护理系统（例如医疗补助、儿童福利、少年司法和行为健康）尤其代表了 相对于年轻人而言，大量重要的“边界人口”自杀和精神疾病的风险更高 普通民众。不幸的是，尽管公共资助的机构中存在大量弱势青年 计划中，人们对这一人群的自杀率和预测因素知之甚少。本研究项目 提议首次创建一个基于人口的综合数据库，将 9 年的数据链接起来 多个俄亥俄州儿童服务机构。这是目前任何其他自杀预防资源都无法比拟的独特自杀预防资源。 联邦数据系统。这项研究有可能提供有关以下方面的深入前瞻性信息： 动态个体和情境因素之间的相互作用可能会有效地应用于 制定有针对性的自杀预防和干预计划。本研究的具体目标 包括三个方面：1) 量化俄亥俄州 4 个公共儿童服务系统内的自杀发生率； 2) 确定公共资助部门青少年自杀的高风险期； 3) 开发和 验证风险预测算法来估计该人群的个体自杀风险。我们的中央 假设是，儿童福利和少年司法计划的进入和退出将与 自杀风险增加，精神卫生保健水平的重大转变也会增加（例如，从 住院到门诊）。这项回顾性纵向队列研究将使用 220 万公共场所青少年的数据 10-24 岁儿童服务系统，将在 2010 年至 2018 年期间进行跟踪。我们采用了一种新颖的多状态 用于检验有关护理转变（目标 2）和时间依赖性 Cox 的假设的统计建模方法 回归分析公共儿童服务系统中青少年自杀的预测因素（目标 3）。这样做的结果 创新研究将确定高风险过渡期，并有助于更好地了解风险 公共资助系统中青少年的自杀率。可行性得到我们现有承诺的支持 国家合作伙伴提供实现我们目标所需的链接数据。