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.

抽象的 自杀是 10-34 岁美洲印第安人和阿拉斯加原住民 (AI/AN) 的第二大死因， 而 25 岁以下的 AI/AN 的发病率比同等年龄的白人高出 6 倍。最多 研究仅限于农村保留地，但 71% 的 AI/AN 居住在城市地区。这个“看不见的 “部落”面临着独特的挑战，因为它与传统家庭和文化缺乏联系。 环境。城市 AI/AN 青年和年轻人比非 AI/AN 面临的风险明显更高 自杀未遂（21% vs. 7%）、严重心理健康问题、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与 上一年曾接受过初级保健提供者的治疗，45% 的人是在去世前一个月接受过治疗。 “筛选，简短 干预和转诊治疗”（SBIRT）是一种基于证据的实践，将行为 初级保健团队中的卫生临床医生通过立即干预大大降低自杀风险 行为健康临床医生。然而，SBIRT 中的保留一直是一个挑战，并且尚未在 城市人工智能/AN 筛查自杀倾向（自杀想法或行为）。我们与2个大型城市合作 印第安人卫生组织 – 西雅图印第安人卫生委员会和原住民社区健康资源 阿尔伯克基评估其现有的 SBIRT 计划。我们还将测试一项新颖的增强功能，该增强功能可发送 关怀短信，改编自类似的基于经验的有效干预措施 预防自杀。这些短信旨在提高 SBIRT 保留率并增强社交和 文化联系，这是防止自杀和死亡的强有力的保护因素。 3年期间 研究中，我们将随机分配 2,400 名 12-34 岁的自杀意念筛查阳性的 AI/AN 患者 常规护理（SBIRT+转介现有资源）或 6 个月 (SBIRT+6) 或 12 个月的 SBIRT (SBIRT+12) 条短信。主要结果将是自我报告的自杀意念、企图和自杀—— 随机分组后 1 年的相关住院治疗。次要结果将包括感知的社会 连接性和保留性。考虑到可持续性的价值，我们也会进行经济评估。 我们的具体目标是： 1) 评估我们研究地点的 SBIRT 计划，以确定并解决影响因素 影响其成功实施； 2) 比较 SBIRT+6 和 SBIRT+12 与常规护理的有效性 减少自杀意念、自杀企图和住院治疗；以及增加社会联系和 SBIRT 中的保留； 3) 对 SBIRT+6 和 SBIRT+12 进行严格的经济评估，与 常规护理检查其对医疗资源使用和生活质量的影响。鉴于耻辱 与精神疾病有关，很少有 AI/AN 青少年和年轻人寻求自杀帮助。保留的挑战 后续行动强调需要临床以外的创新参与方式。我们的工作是一致的 外科医生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。