Predicting and Preventing Suicidal Ideation among High-Risk Sexual and Gender Minority Adolescents

项目摘要 性和性别少数（SGM）青少年自杀的风险增加。约1/3 SGM 青少年报告有自杀企图，而非SGM青少年中有1/10。SGM青少年 他们被认为容易自杀，因为他们必须与青春期的典型压力源谈判， 与SGM身份达成协议，这可能涉及管理与耻辱相关的压力源 包括外部应激源（例如，欺凌）和驾驭繁重的内部心理压力源（例如，身份 隐藏）。这个被提议的K 01的总体目标，名为SPIRiT项目（真实的自杀预测）， 时间），是为了检查与污名相关的压力源（例如，欺凌，身份隐瞒）和 通用硅化物前体（例如，绝望）最近对SGM青少年自杀念头的影响 因急性自杀住院我会利用最先进的实时移动的监控方法 生态瞬时评估（EMA）和全球定位系统（GPS）数据， 该项目的三个目标：（目标1）开发一种EMA+GPS评估方法，能够捕获自我， 通过SGM青少年近期住院患者的焦点小组报告的和基于地点的污名暴露; (Aim 2）通过28天的调查，研究SGM青少年近期住院患者自杀意念的前兆。 EMA+GPS研究;以及（目标3）制定和完善及时适应性干预（JITAI）的组成部分 针对SGM青少年自杀风险，根据目标2参与者焦点小组的定性数据提供信息 并与临床医生和吉泰专家进行了深入访谈。来自SPIRiT项目的证据将为 对于NIMH R 01，以进一步测试高风险SGM的经验性自杀预防JITAI 青少年。为了成功地进行拟议的研究项目，我将：（1）接受创新培训 微纵向研究方法的途径，包括EMA+GPS技术;（2）开发 对临床人群进行负责任研究和解决安全问题的专业知识;以及（3） 掌握技能，发展经验丰富的JITAI，以减少自杀风险。通过参与指导 研究与博士约翰Pachankis（主要导师）和一个专家团队的共同导师和合作者在 耶鲁大学和超越，并参加课程，研讨会，讲习班，科学会议， 定期的指导会议，我将开发必要的技能，成功地执行建议 研究活动，并实现我成为一名独立科学家的长期职业目标。耶鲁大学 提供丰富的知识和实践资源，跨学科的研究和培训环境， 专业发展和合作机会，以支持早期职业调查人员在启动 独立的研究生涯。拟议的K 01将为我提供培训，指导， 保护必要的时间，以建立一个独立的研究计划，重点是SGM的差异， 通过严格的科学调查和干预发展来预防自杀。

PROJECT SUMMARY Sexual and gender minority (SGM) adolescents are at increased risk for suicide. Approximately 1 in 3 SGM adolescents report having attempted suicide compared to 1 in 10 non-SGM adolescents. SGM adolescents are thought to be vulnerable to suicide because they must negotiate typical stressors of adolescence alongside coming to terms with an SGM identity, which can involve managing exposure to stigma-related stressors including external stressors (e.g., bullying) and navigating taxing internal psychological stressors (e.g., identity concealment). The overarching goal of this proposed K01, entitled Project SPIRiT (Suicide Prediction In Real- Time), is to examine the influence of stigma-related stressors (e.g., bullying, identity concealment) and universal suicide precursors (e.g., hopelessness) on suicidal ideation among SGM adolescents recently hospitalized for acute suicidality. I will utilize state-of-the-art real-time mobile monitoring methods incorporating both ecological momentary assessment (EMA) and global positioning system (GPS) data to pursue the project’s three aims: (Aim 1) develop an EMA+GPS assessment approach capable of capturing both self- reported and place-based exposure to stigma through focus groups with SGM adolescent recent inpatients; (Aim 2) examine precursors to suicidal ideation among SGM adolescent recent inpatients through a 28-day EMA+GPS study; and (Aim 3) develop and refine components of a just-in-time adaptive intervention (JITAI) targeting SGM adolescent suicide risk, informed by qualitative data from focus groups with Aim 2 participants and in-depth interviews with clinicians and JITAI experts. Evidence from Project SPIRiT will lay the groundwork for an NIMH R01 to further test an empirically informed suicide prevention JITAI for high-risk SGM adolescents. To successfully conduct the proposed research project, I will: (1) obtain training in innovative approaches to micro-longitudinal research methodology, including EMA+GPS technology; (2) develop expertise in conducting responsible research with clinical populations and addressing safety concerns; and (3) acquire skills in developing an empirically informed JITAI to reduce suicide risk. By engaging in mentored research with Dr. John Pachankis (primary mentor) and an expert team of co-mentors and collaborators at Yale University and beyond, and participating in coursework, seminars, workshops, scientific conferences, and regular mentorship meetings, I will develop the skills necessary to successfully carry out the proposed research activities and meet my long-term career goal of becoming an independent scientist. Yale University offers rich intellectual and practical resources, an interdisciplinary research and training environment, and professional development and collaborative opportunities to support early-career investigators in launching their independent research careers. The proposed K01 will provide me with the training, mentorship, and protected time necessary to establish an independent program of research focused on SGM disparities and suicide prevention through rigorous scientific inquiry and intervention development.