Suicide Prevention with Substance Using Youth Experiencing Homelessness

通过使用无家可归青少年的药物来预防自杀

• 批准号: 10712445
• 负责人: NATASHA SLESNICK
• 金额: $ 78.28万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10712445
• 关键词: Address; Adopted; Adoption; Advocacy; Affect; Cause of Death; Cessation of life; Cognitive; Cognitive Therapy; Communities; Community Services; Complement; Dangerousness; Data; Dehumanization; Drops; Exclusion; Feasibility Studies; Feeling suicidal; Future; Goals; Health Services Accessibility; Homelessness; Hospitalization; Individual; Intervention; Intervention Studies; Knowledge; Literature; Mediating; Mediator; Mental Health; Mental disorders; Methods; Modeling; Outcome; Outcome Study; Pilot Projects; Premature Mortality; Race; Randomized; Reporting; Research; Resources; Risk Factors; Risk Reduction; Sampling; Services; Sex Orientation; Shelter facility; Stress; Suicide; Suicide attempt; Suicide prevention; System; Testing; Theoretical model; Therapeutic Intervention; Time; Victimization; Vulnerable Populations; Youth; adolescent substance use; completed suicide; cost; depressive symptoms; dosage; effective intervention; evidence base; experience; follow up assessment; follow-up; health disparity; human capital; improved; individual response; marginalization; outreach; physical conditioning; poor health outcome; premature; prevent; prevention service; preventive intervention; primary outcome; protective factors; recruit; reducing suicide; secondary outcome; services as usual; sex; social; social exclusion; substance use; suicidal risk; theories; treatment effect; uptake

Project Summary/Abstract While research on substance using youth experiencing homelessness (YEH) is increasing, there is a dearth of information regarding effective prevention interventions for these youth. This is of significant concern because studies indicate that 66% to 89% of YEH have a mental health disorder (Cauce et al., 2004) and 68% report at least one suicide attempt (Gewitz et al., 2020). In fact, suicide is the leading cause of death among YEH (Rotheram-Borus & Milburn, 2004; Yoder et al., 2010). Among those who have attempted suicide, an average of 6.2 attempts is reported, and lifetime suicidal ideation rates range from 14% to 66.5% (Yoder et al., 2010) with no clear evidence of effective interventions for YEH. This study uses general cognitive theory (Beck, 1967), complemented with concepts from two suicide specific theoretical models, to guide our intervention and conceptual change model. Our goal is to test strategies to extend delivery and uptake of a cognitive therapy intervention for YEH. Prior studies focus on service-connected youth, but research suggests that most street living YEH do not access services meant to assist them (Kelly & Caputo, 2007). We overcome prior sampling limitations through engaging service-disconnected youth in addition to service-connected youth through a local drop-in center. As such, three hundred substance using YEH with recent suicidal ideation or a recent suicide attempt will be randomly assigned to Cognitive Therapy for Suicide Prevention (CTSP) + Services as Usual (SAU) (N=150) or to SAU alone (N=150). CTSP has previously shown efficacy for YEH through a RCT pilot feasibility study (Slesnick et al., 2020; Wu et al., 2020). SAU includes outreach, advocacy and service linkage which are typical services offered by agencies serving those experiencing homelessness (Ober et al., 2012). Follow-up assessments will be conducted at 3, 6, 9 and 12-months post-baseline. It is hypothesized that youth receiving CTSP+SAU will show greater reductions in suicidal ideation (primary outcome), substance use and depressive symptoms (secondary outcomes) over time compared to SAU alone, as well as improved risk and protective factors. Theoretically-derived mediators will be tested to shed light on mechanisms associated with change, and the moderating effects of sex, race, sexual orientation and baseline service connection will be examined. In order to ease future dissemination of the intervention to agencies serving YEH, we will rigorously assess acceptability, feasibility, fidelity and cost associated with the delivery of our intervention approach using a mixed-methods approach. Ultimately, the goal of this research is to provide support for the use of a suicide prevention intervention for substance using YEH that reduces premature mortality, hospitalization, and loss of human capital and which can be easily adopted by agencies serving YEH.

项目总结/摘要 虽然对物质使用青年经历无家可归（YEH）的研究正在增加，但缺乏 关于对这些青年采取有效预防干预措施的信息。这是一个重大问题，因为 研究表明66%到89%的YEH有精神健康障碍（Cauce等人，2004年）和68%的报告， 至少一次自杀企图（Gewitz等人，2020年）。事实上，自杀是青年人死亡的主要原因， （Rotheram-Borus & Milburn，2004; Yoder等人，2010年）。在那些试图自杀的人中，平均 的6.2次尝试，并且终生自杀意念率范围为14%至66.5%（Yoder等人，（2010年） 没有明确的证据表明对YEH进行有效的干预。本研究使用一般认知理论（Beck， 1967年），补充了两个自杀特定理论模型的概念，以指导我们的干预和 概念转变模式我们的目标是测试策略，以扩大交付和吸收的认知疗法 干预YH。先前的研究集中在服务连接的青年，但研究表明，大多数街头 生活在YEH中的人无法获得旨在帮助他们的服务（Kelly & Caputo，2007）。我们克服了先验抽样 除了通过当地的服务联系青年外， 临时接待中心因此，300名最近有自杀想法或最近有自杀倾向的YEH使用物质的人， 自杀未遂者将被随机分配到自杀预防认知疗法（CTSP）+服务 SAU（N=150）或单独SAU（N=150）。CTSP先前已通过以下方式显示出对YEH的疗效： RCT试点可行性研究（Slesnick等人，2020年; Wu等人，2020年）。战略行动股包括外联、宣传和 服务联系，这是为无家可归者提供服务的机构提供的典型服务（Ober 例如，2012年）。将在基线后3、6、9和12个月进行随访评估。是 假设接受CTSP+SAU的青少年将显示自杀意念（主要 结果），物质使用和抑郁症状（次要结果）随着时间的推移与SAU单独相比， 以及改善的风险和保护因素。理论推导的介质将进行测试，以阐明 与变化相关的机制，以及性别、种族、性取向和基线的调节作用 将检查服务连接。为了便于将来向各机构传播干预措施， 服务于YEH，我们将严格评估与交付相关的可接受性，可行性，保真度和成本， 我们的干预方法采用混合方法。最终，这项研究的目标是提供 支持对使用YEH的物质进行自杀预防干预， 死亡率、住院率和人力资本损失，这些都可以很容易地被为YEH服务的机构所采用。