Collaborative Hub to Reduce the Burden of Suicide among Urban American Indian and Alaska Native Youth

减轻城市美洲印第安人和阿拉斯加原住民青年自杀负担的合作中心

• 批准号: 10186827
• 负责人: SPERO MARTIN MANSON
• 金额: $ 82.63万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186827
• 关键词: Accreditation; Address; Adoption; Affect; Age; Alaska; Alaska Native; American Indians; American Psychiatric Association; Behavior; Caring; Cause of Death; Cessation of life; Clinic; Clinical; Communication Methods; Communities; Current Procedural Terminology Codes; Data; Detection; Environment; Equation; Event; Evidence based intervention; Evidence based practice; Face; Family; Feeling suicidal; Health; Health Technology; Healthcare; Hospitalization; Institutes; Intervention; Joints; Life; Marriage; Mediating; Mental Depression; Mental Health; Mental disorders; Outcome; Participant; Patient Care; Patient Self-Report; Patients; Population; Pregnancy in Adolescence; Prevention Research; Primary Health Care; Process; Protocols documentation; Public Health Practice; Quality of life; Randomized; Randomized Controlled Trials; Reporting; Research; Reservations; Resources; Risk; Risk Factors; Rural; Services; Site; Structure; Substance abuse problem; Suicide; Suicide attempt; Suicide prevention; Surgeon; System; Testing; Text Messaging; Thinking; Time; Treatment outcome; Triage; Tribes; Work; Youth; base; behavioral health; behavioral health intervention; care providers; compare effectiveness; cost effective; economic evaluation; effective intervention; evidence base; follow-up; gang; health care service organization; health organization; help-seeking behavior; high risk; improved; innovation; intervention effect; mHealth; native youth; novel; primary outcome; protective factors; psychological trauma; reducing suicide; response; screening; screening, brief intervention, referral, and treatment; secondary outcome; social; social stigma; stem; success; suicidal behavior; suicidal risk; suicide rate; treatment as usual; treatment program; urban Native American; urban area; young adult

ABSTRACT Suicide is the second leading cause of death for American Indian and Alaska Native (AI/ANs) ages 10-34, while rates for AI/ANs younger than 25 years are up to 6 times higher than for Whites of similar ages. Most research has been limited to rural reservation settings, yet 71% of AI/ANs reside in urban areas. This “invisible tribe” faces unique challenges stemming from its lack of connection with traditional family and cultural environments. Urban AI/AN youth and young adults are at notably higher risk than their non-AI/AN counterparts for attempted suicide (21% vs. 7%), and for serious mental health problems, substance abuse, gang activity, teen pregnancy, and interpersonal abuse. Yet, most people who die by suicide have contact with a primary care provider in the prior year, and 45% are seen in the month before their death. “Screening, Brief Intervention, and Referral to Treatment” (SBIRT) is an evidence-based practice that co-locates behavioral health clinicians in primary care teams and substantially reduces suicide risk through immediate intervention by behavioral health clinicians. However, retention in SBIRT has been a challenge and it has not been tested in urban AI/ANs to screen for suicidality (suicidal thoughts or behaviors). We have partnered with 2 large Urban Indian Health Organizations – the Seattle Indian Health Board and First Nations Community Healthsource in Albuquerque to evaluate their existing SBIRT programs. We will also test a novel enhancement that sends caring text messages, which have been adapted from similar empirically-based, effective interventions for suicide prevention. The text messages are intended to improve SBIRT retention and increase social and cultural connectedness, which are strong protective factors against suicidality and death. During the 3-year study, we will randomly assign 2,400 AI/AN patients ages 12-34 who screen positive for suicidal ideation to usual care (SBIRT+referral to existing resources) or SBIRT with either 6 months (SBIRT+6) or 12 months (SBIRT+12) of text messages. Primary outcomes will be self-reported suicidal ideation, attempts, and suicide- related hospitalizations for 1 year after randomization. Secondary outcomes will include perceived social connectedness and retention. Given the value of sustainability, we will also conduct an economic evaluation. Our Specific Aims are to: 1) Evaluate SBIRT programs at our study sites to identify and address factors that affect their successful implementation; 2) Compare the effectiveness of SBIRT+6 and SBIRT+12 to usual care for reducing suicidal ideation, attempts, and hospitalizations; and for increasing social connectedness and retention in SBIRT; and 3) Perform an rigorous economic evaluation of SBIRT+6 and SBIRT+12 compared to usual care to examine their effects on use of healthcare resources and quality of life. Given the stigma attached to mental illness, few AI/AN youth and young adults seek help for suicidality. Challenges of retention and follow-up underscore the need for innovative means of engagement beyond the clinic. Our work is aligned with the Surgeon General's National Strategy for Suicide Prevention that identifies connectedness to others as the primary protective factor against suicidality.

摘要 自杀是10-34岁美国印第安人和阿拉斯加原住民(AI/ANS)的第二大死因， 而25岁以下的人工智能/AN的比率比同龄白人高出6倍。多数 研究一直局限于农村保留地，但71%的人工智能/人工智能居住在城市地区。这是“看不见的 部落面临着独特的挑战，因为它与传统的家庭和文化缺乏联系 环境。城市人工智能/AN青年和年轻人的风险明显高于他们的非AI/AN 自杀未遂(21%比7%)，严重精神健康问题，药物滥用， 帮派活动、青少年怀孕和人际虐待。然而，大多数自杀身亡的人都接触过 前一年的初级保健提供者，45%的人在死亡前一个月就诊。“筛选，简要 干预和转诊到治疗“(SBIRT)是一种基于证据的实践，它将行为 初级保健团队中的健康临床医生，并通过以下方式立即干预大幅降低自杀风险 行为健康临床医生。然而，在SBIRT中保留一直是一个挑战，它还没有在 城市人工智能/人工智能筛查自杀行为(自杀想法或行为)。我们已经与两家大型城市公司合作 印度卫生组织-西雅图印第安人健康委员会和第一民族社区卫生来源 阿尔伯克基评估他们现有的SBIRT计划。我们还将测试一种新的增强功能，它将发送 关爱短信，改编自类似的基于经验的有效干预措施 防止自杀。短信的目的是改善SBIRT的保留率，增加社交和 文化联系，这是防止自杀和死亡的强大保护因素。在3年内 研究中，我们将2400名年龄在12-34岁、自杀意念呈阳性的AI/AN患者随机分配给 常规护理(SBIRT+转诊至现有资源)或SBIRT，为期6个月(SBIRT+6)或12个月 (SBIRT+12)的短信。主要结果将是自我报告的自杀念头、企图和自杀- 随机分组后相关住院1年。次要结果将包括感知的社交 连接性和保留性。鉴于可持续发展的价值，我们还将进行经济评估。 我们的具体目标是：1)评估我们研究地点的SBIRT计划，以确定和解决以下因素 影响其成功实施；2)比较SBIRT+6和SBIRT+12与常规护理的效果 用于减少自杀念头、企图和住院；以及增加社会联系和 在SBIRT中保留；以及3)对SBIRT+6和SBIRT+12进行严格的经济评估 常规护理，以检查其对医疗资源使用和生活质量的影响。考虑到耻辱 由于患有精神疾病，很少有AI/AN青少年和年轻人因自杀而寻求帮助。留存的挑战 后续行动强调了超越诊所的创新参与手段的必要性。我们的工作是一致的 卫生局局长的国家自杀预防战略将与他人的联系确定为 防止自杀的主要保护因素。