Adolescent Emergency Patients: Suicide Risk Detection and Treatment Facilitation

说明(申请人提供)：自杀是美国青少年死亡的第三大原因；然而，超过50%的自杀青少年从未获得过任何精神健康服务。根据《国家预防自杀战略》(2001)中的建议，R34探索性研究项目将开发一种干预措施，每年有可能提供给数千名寻求紧急服务的高危青少年。我们将开发和试点一种理论驱动的干预措施，青少年选择改变(TOC)，旨在提高处于不利地位的城市青少年中因以下两种原因而有自杀风险的问题识别、变化准备和治疗联系：(1)共存的抑郁和酗酒，或(2)最近的自杀行为(自杀企图或严重自杀想法)。TOC结合了动机访谈原则，并以健康行为促进模式为基础。干预部分包括为青少年提供个性化反馈的改编动机访谈(AMI)、侧重于父母和青少年可用的治疗的简短联合AMI、使用文化定制的服务信息和决策援助，以及个性化的后续笔记。具体目标是：(1)开发TOC材料(干预手册；为文化量身定做的服务信息和决策援助；治疗师培训和忠诚度评估程序)；(2)进行可行性初步研究，完善随机对照试验的干预措施和程序；以及(3)进行一项试点随机对照试验，将TOC与常规强化治疗进行比较。这项试验将使我们能够(A)在条件下估计主要和次要结果的分布和变异性；以及(B)确定TOC的社会接受度和有效性。在这项试验中，将对1120名青少年进行筛查，以确定109名符合自杀风险标准并(在父母同意的情况下)同意参与的青少年。在2个月时评估的主要结果是寻求治疗(根据参与程度的二分法定义)。二次分析将涉及(1)对寻求治疗的干预效果，调整其他可能的预测因素，如年龄、性别和病情严重程度；以及(2)寻求治疗对青少年结果的影响程度。这个项目利用了我们的跨学科团队在干预自杀青少年、基于紧急情况的酒精滥用干预、激励性访谈以及为健康行为制定文化定制决策指南方面的丰富经验。该团队在青少年自杀风险管理方面的丰富经验加强了该项目的可行性。

DESCRIPTION (provided by applicant): Suicide is the 3rd leading cause of death among adolescents in the United States; however, more than fifty percent of adolescents who die from suicide have never obtained any mental health services. In keeping with recommendations in the National Strategy for Suicide Prevention (2001), this R34 Exploratory Research Project will develop an intervention that has the potential to be delivered to thousands of at risk adolescents seeking emergency services each year. We will develop and pilot test a theoretically-driven intervention, Teen Options for Change (TOC), which is designed to improve problem recognition, readiness for change, and treatment linkage among disadvantaged urban adolescents at risk for suicide due to either (1) co-occurring depression and alcohol misuse, or (2) recent suicidality (suicide attempt or severe suicidal ideation). TOC incorporates motivational interviewing principles and is based on health behavior promotion models. Intervention components include an Adapted Motivational Interview (AMI) with Personalized Feedback for the adolescent, a brief conjoint AMI focusing on available treatments for the parent and adolescent, use of a culturally tailored Services Information and Decision Aid, and Personalized Follow-Up Notes. Specific aims are: (1) to develop TOC materials (intervention manual; culturally tailored Services Information and Decision Aid; therapist training and fidelity assessment procedures); (2) to conduct a feasibility pilot study to refine the intervention and procedures for the randomized controlled trial; and (3) to conduct a pilot randomized controlled trial comparing TOC to enhanced treatment-as-usual. This trial will enable us (a) to estimate the distribution and variability of primary and secondary outcomes within conditions; and (b) to determine the social acceptance and validity of TOC. In this trial, 1120 adolescents will be screened to identify 109 who meet suicide risk criteria and assent (with parental consent) to participate. The primary outcome, assessed at 2-months, is treatment seeking (defined dichotomously and by level of engagement). Secondary analyses will address (1) the intervention effect on treatment seeking, adjusting for other possible predictors such as age, gender, and severity of index condition; and (2) the extent to which treatment-seeking impacts adolescent outcomes. This project capitalizes upon our interdisciplinary team's substantial experience with interventions for suicidal adolescents, emergency-based interventions for alcohol misuse, motivational interviewing, and the development of culturally tailored decision guides for health behaviors. The project's feasibility is strengthened by the team's extensive experience with adolescent suicide risk management.