Quantifying Real-world Effectiveness of Mental Health Interventions for Suicide Prevention in At-risk Adolescent and Transitional Age Youth

项目总结和摘要-剑桥健康联盟 ALACRITY for Early Screening and Treatment of High Risk Youth（eSToRY） R34 -量化心理健康干预在预防自杀方面的现实效果- 风险青少年和过渡年龄青少年 为种族/民族和语言（REL）的不同人群确定有效的自杀预防策略 自杀风险高的青少年对公共卫生有重大意义。10-24岁人口的自杀率 在过去的十年里，几乎每个州和几乎每个种族/民族都增加了50%以上 少数群体，特别是关于黑人青年自杀企图的增加。在这个项目中， 我们利用一个独特的临床社会背景数据集，其中包括15,000多名自杀高危青年患者， 开展社区精神卫生高维度比较效果研究（CER） 在不同性别的青少年中预防自伤思想和行为的干预措施， 过渡年龄青年。我们利用了一个巨大的仓库临床，保险，刑事司法，个人- 和社区一级的健康数据的社会决定因素，以多维度匹配治疗和控制 群体，并评估不同的社区为基础的治疗制度对自杀结果的影响。 在目标1中，我们提出了创新的比较有效性研究，使用大型回顾性临床研究， 社会背景数据集，以确定预防自杀的有效治疗方法，以及这些方法在 REL多元化群体。 在目标2中，我们确定了该队列的一个子样本，在我们的回顾性分析之后， 一个计算机化的适应性测试，分析当今的自杀结果，精神病理学，和社会措施， 健康和护理质量的决定因素。这将有助于评估长期治疗结果， 未观察到的变量可能会影响比较有效性研究结果。 本研究为两项R 01水平研究奠定了基础：1）一项更大规模的CER试验， 多个机构; 2）一项序贯多分配随机试验（SMART），评估 系统适应性治疗对自杀结局的影响。该项目将有助于更好地 理解是否、如何、何时以及为谁改变持续时间、频率、类型或交付 在治疗过程中的关键步骤进行治疗，从而采取干预措施， 在弱势群体中的自杀倾向。

PROJECT SUMMARY AND ABSTRACT – Cambridge Health Alliance ALACRITY for Early Screening and Treatment of High Risk Youth (eSToRY) R34 - Quantifying real-world effectiveness of mental health interventions for suicide prevention in at- risk adolescent and transitional age youth Identifying effective suicide prevention strategies for racial/ethnic and language (REL)-diverse populations of youth at high risk of suicide has enormous public health importance. Suicide rates for persons aged 10–24 have increased by more than 50% over the last decade in nearly every state and for nearly every racial/ethnic minority group, with particularly concerning increases in suicide attempts among Black youth. In this project, we utilize a unique clinical-sociocontextual dataset of over 15,000 youth patients at high risk for suicide to conduct high-dimensional comparative effectiveness research (CER) of community-based mental health interventions in the prevention of self-injurious thoughts and behaviors among REL-diverse adolescents and transitional age youth. We leverage an enormous warehouse of clinical, insurance, criminal justice, individual- and neighborhood-level social determinants of health data to multi-dimensionally match treatment and control groups and assess the impact of differing community-based treatment regimes on suicidal outcomes. In Aim 1, we propose innovative comparative effectiveness research using a large retrospective clinical- sociocontextual dataset to identify effective treatments for suicide prevention, and how these differ across REL-diverse groups. In Aim 2, we identify a sub-sample of this cohort in the present day, following up our retrospective analysis with a computerized adaptive test analyzing current day suicidal outcomes, psychopathology, and measures social determinants of health and quality of care. This will allow for assessment of long-run treatment outcomes, and how unobserved variables may bias comparative effectiveness research results. This study lays the groundwork for two R01-level studies: 1) a larger CER trial of treatment regimes across multiple institutions; and 2) a sequential multiple assignment randomized trial (SMART) that evaluates the impact of systematic adaptation of treatment on suicide outcomes. The project will contribute to a better understanding of whether, how, when, and for whom to alter the duration, frequency, type, or delivery of treatments at pivotal steps in the episode of treatment, leading to interventions that will reduce the risk of suicidality in vulnerable REL-diverse populations.