Preventing Youth Suicide in Primary Care: A Family Model

青少年自杀是一个严重的公共卫生问题，也是医疗和行为健康提供者面临的临床挑战。然而，针对这一人群的预防性干预措施却很少。本项目通过测试在初级保健环境中对有严重自杀风险的青少年进行简短家庭治疗的效果，解决了这一缺陷。这项研究有几个创新之处。首先，患者将在初级保健机构直接得到识别和治疗。将行为健康服务纳入初级保健可a)通过促进家长作为安全监督者减轻医生的负担，b)增进行为健康

Youth suicide is a serious public health problem and clinical challenge for medical and behavioral health providers. Yet few preventive interventions have been tested for this population. This project addresses this deficit by testing the efficacy of a brief family therapy for adolescents presenting with serious risk for suicide in a primary care setting. Several innovations characterize the study. First, patients will be identified and treated directly in the primary care setting. Integrating behavioral health services into primary care may a) reduce burden on physicians by promoting parents as safety monitors, b) increase behavioral health treatment adherence, and c) address many underlying family problems associated with suicide. Second, to identify seriously at risk adolescents, we will assess for severe and persistent suicidal ideation and cooccurring depression. Patients will need to score above clinical cutoffs on both ideation (SIQ > 31) and depression (BDI-II >20) at two consecutive appointments (generally within 3 days of each other). Third, treatment will target two of the most critical suicide risk factors: depression and family conflict. Depression is the most consistently associated risk factor for suicide and family conflict is the most common precipitant of completed suicide (20%) and non-fatal suicidal episodes (50%). Fourth, we will use Attachment Based Family Therapy (ABFT; Diamond et al., 2002) as the intervention approach, an efficacious and manualized family therapy model specifically designed for adolescent depression. ABFT has been successful in reducing suicidal ideation, hopelessness, depression, anxiety, and family conflict. The Children's Hospital of Philadelphia's Adolescent Care Center will be the performance site, where typically 1 to 3 adolescents a week present with severe and current ideation. Eighty-seven percent of patients are African American and 60% are girls. One-hundred and twenty adolescents will be randomized to 6 to 10 weeks of either ABFT or Enhanced Usual Care (EUC). Patients will be evaluated at baseline 6, 12, 24, and 52 weeks.