The Center for Enhancing Treatment and Utilization for Depression and Emergent Suicidality (ETUDES) in Pediatric Primary Care

本申请为以实践为基础的自杀预防中心(PAR-20-286)，培训(加强治疗 和对抑郁和突发自杀的利用)是我们目前敏捷的竞争性更新P50。我们 旨在解决青少年自杀危机，特别关注黑人青年，他们的自杀率 尝试的增长速度比其他任何人口群体都要快。我们将开发并测试有效的 易于在儿科部署的识别和干预自杀高危青年的方法 初级保健(PPC)。我们关注PPC，因为大多数年轻人每年都会访问PPC，年轻人会定期接受筛查 每年抑郁症和自杀风险，初级保健中提供的心理健康治疗可能会减少 机会和成果方面的差距。我们着重于以下策略来减少自杀行为：(1) 改进识别以补充筛查；(2)促进与服务和安全规划的联系；以及(3) 以抑郁和自杀的风险因素为目标，防止自杀危机的发生。在第一个组件中 对于我们的签名R01，我们将使用EHR开发结合机器学习算法的预测模型 数据和移动感应，以改进我们对2000名青年队列中即将到来的自杀风险的检测，招募 来自PPC。在R01的第二组分中，我们将对这一子集进行随机对照试验 队列，900名有自杀倾向的年轻人，将常规护理与我们开发的一套工具进行比较，以帮助PPC提供者 评估和管理有自杀倾向的青少年。在以前的工作中，这些工具增加了医生对心理健康的转介 和参与治疗，并减少自杀行为。我们提出了三个R34，目标是 增加抑郁和自杀的风险，即网上受害、缺乏活动/快感和睡眠不佳。 为了解决黑人青年自杀行为上升的全国性危机，我们将招募至少 35%为黑色，并应用实施科学方法来确保所有评估和干预措施 对于黑人青年及其家庭来说，这是可以接受和有效的。此外，我们的识别和识别方法 干预措施针对自杀行为中种族差异的可能来源，即在线治疗机会 受害，活动少，睡眠不佳。该中心更新召集了一个多元化、跨学科的团队， 在临床试验和纵向研究、机器学习、移动传感、健康差异以及 实施科学。所有目标都是通过与利益相关者的合作来指导的，其中一些利益相关者扮演着领导者的角色 中心中的角色。该中心的主要任务是培训和支持早期10个不同的团体 在中心项目中扮演关键角色的职业科学家。如果成功，中心项目应该会产生预测性的 针对即将到来的自杀风险的算法，以补充自杀青少年的年度筛查，这是一种护理途径 这可以在PPC中实施，并将大大减少与自杀有关的事件和干预措施，以防止 抑郁和自杀行为。这些工具旨在通过改善自杀行为来减少自杀行为的种族差异 识别和获取，并针对黑人青年中更普遍的风险因素。

This application for a Practice-based Suicide Prevention Center (PAR-20-286), ETUDES (Enhancing Treatment and Utilization for Depression and Emergent Suicidality) is a competitive renewal of our current Alacrity P50. We aim to address the crisis in adolescent suicide, with special attention to Black youth, for whom the rate of suicide attempts has increased more rapidly than in any other demographic group. We will develop and test effective methods for identifying and intervening with youth at risk for suicide that can be readily deployed in pediatric primary care (PPC). We focus on PPC because most youth visit PPC annually, youth are routinely screened annually for depression and suicidal risk, and mental health treatment delivered in primary care can decrease disparities in access and outcomes. We focus on the following strategies to reduce suicidal behaviors: (1) improved identification to complement screening; (2) promote linkages to services and safety planning; and (3) targeting risk factors for depression and suicidality to prevent the onset of suicidal crises. In the first component of our signature R01, we will develop prediction models that combine machine learning algorithms using EHR data and mobile sensing to improve our detection of imminent suicidal risk in a cohort of 2,000 youth, recruited from PPC. In the 2nd component of the R01, we will conduct a randomized controlled trial on a subset of this cohort, 900 suicidal youth, comparing usual care to a suite of tools that we have developed to help PPC providers assess and manage suicidal youth. In previous work, these tools increased physician referrals to mental health and engagement in treatment, and reduced suicidal behavior. We propose three R34s that target domains that increase risk for depression and suicidality, namely, online victimization, low activity/anhedonia, and poor sleep. To address the national crisis of rising suicidal behavior in Black youth, we will recruit a sample that is at least 35% Black, and apply implementation science methods to ensure that all assessments and interventions are acceptable and effective for Black youth and their families. Moreover, our methods of identification and interventions target probable sources of racial disparities in suicidal behavior, namely, treatment access, online victimization, low activity, and poor sleep. This Center renewal convenes a diverse, interdisciplinary team, with expertise in clinical trials and longitudinal studies, machine learning, mobile sensing, health disparities, and implementation science. All aims are guided by collaboration with stakeholders, some of whom play leadership roles in the Center. Primary to the Center’s mission is the training and support of a diverse group of 10 early career scientists who play critical roles in Center projects. If successful, Center projects should yield predictive algorithms for imminent suicidal risk to complement annual screening, a care pathway for suicidal adolescents that can be implemented in PPC and will substantially reduce suicide-related events, and interventions to prevent depression and suicidal behavior. These tools aim to reduce racial disparities in suicidal behavior by improving identification, and access, and by targeting risk factors that are more prevalent among Black youth.