Expanding the Geospatial Identification of Elevated Suicide Risk (GIESR) Method to Identify Neighborhood Level Risk and Protective Factors for Youth Suicide Ideation and Attempts

项目摘要 自杀是美国青少年死亡的第二大原因。 预防自杀倡议呼吁发展社区预防服务， 1然而，我们对与自杀行为相关的社区水平变量的认识存在很大差距。 2发展社区自杀预防方法的关键下一步是 确定可修改的目标机制，用于公共卫生干预。我们的目标是 建议是确定与自杀风险相关的可修改的候选机制， 邻里水平。我们的团队已经提出并检验了一种统计方法， 随着社区内自杀意念和企图率的升高， 自杀风险升高（GIESR）。GIESR方法利用常规自杀风险筛查 在医疗机构内进行。GIESR利用电子健康记录数据绘制了 自杀意念和企图在一个定义的地理集水区。对全球经济、社会和文化权利全球倡议的进一步评价 模型，复制和扩展这种方法，将支持识别 青少年自杀意念和企图的邻里水平风险和保护因素。 该项目有两个主要目标：目标1将复制和扩展GIESR方法， 心理测量特性，并创建一个实施指南，使GIESR可以独立复制 并被其他人用于发展以社区为基础的自杀预防计划。GIESR方法 将使用得克萨斯州儿童医院的数据进行检查，并在更大范围内绘制青少年自杀风险图。 休斯顿都会区。在目标2中，我们将应用GIESR方法来识别风险和保护因素 与青少年自杀意念率和社区自杀未遂率相关。目标2包括 合并多个公共卫生数据集，包括社会经济、犯罪和安全数据，沿着 利用空间测绘数据和GIESR生成的数据， 社区层面的自杀因素。 该提案推进了NIMH战略计划的目标，即目标4，战略4.1，利用“电子健康” 记录.以确定改善服务获取、交付和成果的可变目标”，并促进数据- 33研究结果将为GIESR的使用提供信息 方法，以确定其他社区的高风险领域，并将告知社区的发展- 基于针对已确定的风险和保护因素的自杀预防工作。

PROJECT SUMMARY Suicide is the second leading cause of death among adolescents in the United States.34 The National Strategy for Suicide Prevention calls for the development of community preventive services that will reduce the risk for suicidal behaviors.1 Yet there is a substantial gap in our knowledge of community level variables associated with suicide risk.2 A critical next step toward developing community suicide prevention approaches is the identification of modifiable target mechanisms for use in public health interventions. Our objective in this proposal is to identify modifiable candidate mechanisms associated with suicide risk at the neighborhood level. Our team has proposed and examined a statistical method for identifying localized areas with elevated rates of suicidal ideation and attempts within the community, the Geospatial Identification of Elevated Suicide Risk (GIESR) method. The GIESR method capitalizes on routine suicide risk screening conducted within healthcare settings. GIESR draws on electronic health records data to map the prevalence of suicide ideation and attempts within a defined geographic catchment area. Further evaluation of the GIESR model, to replicate and extend this methodological approach, will support the identification of neighborhood level risk and protective factors for youth suicidal ideation and attempts. The project has two primary aims: Aim 1 will replicate and extend the GIESR method to evaluate its psychometric properties and to create an implementation guide, so that GIESR can be independently replicated and used by others for the development of community-based suicide prevention programs. The GIESR method will be examined using data from Texas Children’s Hospital and mapping youth suicide risk within the greater Houston metropolitan area. In Aim 2, we will apply the GIESR method to identify risk and protective factors associated with rates of youth suicide ideation and attempts at the neighborhood level. Aim 2 includes the merging of multiple public health focused data sets, including socioeconomic, crime, and safety data, along with spatial mapping data and data generated by GIESR, to allow the identification of salient risk and protective factors for suicide at the community level. This proposal advances the goals of the NIMH Strategic Plan, Goal 4, Strategy 4.1, to utilize “electronic health records… to identify mutable targets for improving service access, delivery, and outcomes” and to promote data- driven approaches to identify novel targets for preventive interventions.33 Findings will inform use of the GIESR method to identify areas of elevated risk in other communities and will inform the development of community- based suicide prevention efforts targeting identified risk and protective factors.