3/4 Adapting Treatments for Suicidal College Students: A Multisite Trial

项目摘要 自杀是大学生的第二大死因，自杀意念和自杀相关 在负担过重的大学咨询中心(CCCS)，行为是一个经常出现的问题。 研究表明，一些学生对治疗反应迅速，而另一些学生需要的治疗要多得多 资源。需要基于证据的适应性治疗策略(ATS)来解决这种异质性 责任感和复杂性。ATS通过指定类型和类型如何的决策规则个性化治疗 干预的强度可以根据风险因素、反应或遵从性进行排序。我们是 提出一项通过SMART(顺序、多任务、 随机试验)，以解决寻求治疗的大学生的自杀风险。这项多站点研究(大学 雷诺内华达大学；俄勒冈杜克大学；罗格斯大学)，为回应RFA- MH-18-700，临床试验协作R01，将招收中度至严重自杀的大学生 “初露头角”阶段(18-25岁)在CCCS寻求服务。这一智能将有两个阶段 干预。在第一阶段，来自四个CCC的700名参与者将被随机分配到4-8周：1)a 以自杀为重点的治疗--自杀倾向的合作评估和管理(CAMS)或2)治疗 像往常一样(TAU)。对任何一种干预都有足够的响应者将停止服务/被下台。非- 应答者将被重新随机分配到两种第二阶段更高强度/剂量干预选项中的一种 额外的4-16周：1)CAMS(继续或首次实施)或2)全面 辩证行为疗法(DBT)，包括个人治疗、技能小组和电话/短信辅导 为客户服务，为治疗师提供同行咨询。本研究项目的目的是：1)比较 四种安非他明类药物对减少学生自杀意念、非自杀性自伤和自杀企图的效果； 2)评估是否如假设的那样，以自杀为重点的治疗方法开始的序列(即， 在降低自杀风险方面比TAU更有效；3)确定是否如假设的那样，更多的 综合的、以自杀为重点的方法(即DBT)作为第二阶段干预更有助于 响应人员不足，相对于不那么密集的自杀重点方法(即，CAMS)；4)评估 改变导致每种治疗方法自杀风险降低的机制；具体地说，评估自杀风险 认知在CAMS中的中介作用和情绪调节为基础的加工和技能在CAMS中的调节作用 DBT；5)检查基线因素作为治疗结果的预测和/或调节因素；6)评估 在CCC环境中使用这些兴奋剂的传播潜力和成本效益。这项研究将 就如何最好地分配有限的资源以缓解日益增长的公众压力，向CCCS提供基本指导 健康危机。

Project Summary Suicide is the 2nd leading cause of death among college students and suicidal ideation and suicide-related behaviors are a frequent presenting problem at college counseling centers (CCCs), which are overburdened. Studies show that some students respond rapidly to treatment, whereas others require considerably more resources. Evidence-based adaptive treatment strategies (ATSs) are needed to address this heterogeneity in responsivity and complexity. ATSs individualize treatment via decision rules specifying how the type and intensity of an intervention can be sequenced based on risk factors, response, or compliance. We are proposing a multisite study to investigate ATSs through a SMART (sequential, multiple assignment, randomized trial) to address suicidal risk in treatment-seeking college students. This multisite study (University of Nevada, Reno; Duke University, University of Oregon; Rutgers University), submitted in response to RFA- MH-18-700, Collaborative R01s for Clinical Trials, will enroll moderately to severely suicidal college students in the “emerging adulthood” phase (ages 18-25) seeking services at CCCs. This SMART will have two stages of intervention. In the first stage, 700 participants from four CCCs will be randomized to 4-8 weeks of: 1) a suicide-focused treatment – Collaborative Assessment and Management of Suicidality (CAMS) or 2) Treatment as Usual (TAU). Sufficient responders to either intervention will discontinue services/be stepped down. Non- responders will be re-randomized to one of two second-stage higher intensity/dosage intervention options for an additional 4-16 weeks: 1) CAMS (either continued or administered for the first time) or 2) Comprehensive Dialectical Behavior Therapy (DBT), which includes individual therapy, skills groups, and phone/text coaching for the clients and peer consultation for the therapists. The aims of this research project are to 1) compare the efficacy of the four ATSs in reducing students’ suicidal ideation, non-suicidal self-injury, and suicide attempts; 2) evaluate whether, as hypothesized, a sequence that starts with a suicide-focused treatment approach (i.e., CAMS) is more effective in reducing suicidal risk than TAU; 3) determine whether, as hypothesized, a more comprehensive, suicide-focused approach (i.e., DBT) is more helpful as a second stage intervention for insufficient responders, relative to a less intensive suicide-focused approach (i.e., CAMS); 4) assess the mechanisms of change leading to reduced suicidal risk for each treatment; specifically, to evaluate suicidal cognitions as a mediator in CAMS and emotion regulation-based processes and use of skills as mediators in DBT; 5) examine baseline factors as predictors and/or moderators of treatment outcome; 6) evaluate the dissemination potential and cost effectiveness of using these ATSs within a CCC setting. This study will provide essential guidance to CCCs on how to best allocate limited resources to alleviate an increasing public health crisis.