Effectiveness and Implementation of a Peer Mentorship Intervention (PREVAIL) to Reduce Suicide Attempts Among High-Risk Adults

项目摘要 自杀是主要的死亡原因，在美国发生的大约100万起自杀未遂事件 每年都是重大的社会和公共卫生负担。被确定为自杀高危的个人包括 经常因住院精神健康治疗而入院；然而，已知的干预措施很少减少 在出院后的高危时期自杀或企图自杀。同伴支持是一种新颖的 解决两个经验性支持的自杀危险因素--归属感受挫的干预方法 和绝望，在高风险时期。盛行是一种预防自杀的干预措施，是在 研究将由同伴支持专家提供，这些专家是有过心理健康经历的个人 已经实现稳定复苏并接受培训以支持其他处于风险中的人的挑战。大奖由三个部分组成 在为期数月的一对一会议中，同伴支持专家分享他们与自杀和 参与半结构化的讨论，以提高受助者的希望和归属感。 资助了普罗维利R01有效性实施试验，以确定普罗维利是否 有效地减少自杀企图和自杀念头，无论绝望和 归属感解释自杀相关结果的改善，并找出障碍和促进者 落实卫生系统普惠制。试验已经成功地满足了招募工作的需要 里程碑直到2020年3月，届时两个参与住院单位的面对面招聘都将因此停止 新冠肺炎大流行。在接下来的一年里，实施了新的议定书，以 远程招募患者并最终返回面对面招聘；然而，在 每个地点和招聘率继续低于大流行之前。由于受到影响， 新冠肺炎，这项研究将无法达到其最初的招募目标，即490名注册参与者 剩余预算和时间表。招聘不足如果得不到解决，将不利地限制 一项研究，旨在发现自杀未遂的主要结果方面的差异。 为了应对新冠肺炎的影响，我们建议增加一个招聘网站，以实现原来的 目标招生以试用为准，并实现足够的权力，以确定同行的有效性 减少自杀企图的专家干预。额外的地点将是一个有48张床位的住院病房 亨利·福特医疗系统，之所以选择它，部分原因是这项研究已经收到了机构 审查董事会对目前亨利·福特招聘网站的批准。通过实现我们的完整研究样本，我们还 建议将干预措施的远程实施与面对面实施进行比较，以衡量可接受性和 自杀念头。由于新冠肺炎疫情，流行干预从主要的面对面干预转变为 主要是远程(电话或视频)传递，效果不清楚。这些分析将提供重要的指导 为卫生系统实施普惠制和其他类似的同行支持干预措施。

PROJECT ABSTRACT Suicide is a leading cause of death, and the approximately 1 million suicide attempts that occur in the US each year represent a major societal and public health burden. Individuals identified as high risk for suicide are often admitted for inpatient mental health treatment; however, there are few interventions known to reduce suicides or suicide attempts during the high-risk period after hospital discharge. Peer support is a novel intervention approach to address two empirically supported risk factors for suicide, thwarted belongingness and hopelessness, during high-risk periods. PREVAIL is a suicide prevention intervention developed in a prior study to be delivered by peer support specialists, individuals with a lived experience of mental health challenges who have achieved stable recovery and are trained to support others at risk. PREVAIL consists of 3 months of one-to-one sessions in which peer support specialists share their experiences related to suicide and engage in semi-structured discussions to improve hope and belongingness among recipients. The PREVAIL R01 effectiveness-implementation trial was funded to determine whether PREVAIL is effective at reducing suicide attempts and suicidal ideation, whether improvement in hopelessness and belongingness explain improvements in suicide-related outcomes, and to identify barriers and facilitators to implementation of PREVAIL by health systems. The trial had been successfully meeting its recruitment milestones until March 2020 when in-person recruitment at both participating inpatient units was stopped due to the COVID-19 pandemic. Over the course of the subsequent year new protocols were put into place to recruit patients remotely and eventually return to in-person recruitment; however, the number of admissions at each site and the rate of recruitment continues to be lower than prior to the pandemic. Due to the impact of COVID-19, the study will not be able to reach its original recruitment goal of 490 enrolled participants under the remaining budget and timeline. The recruitment shortfall, if not addressed, will adversely limit the power of the study to detect a difference with respect to the primary outcome of suicide attempts. To address the impact of COVID-19, we propose to add an additional recruitment site to achieve the original target enrollment of the PREVAIL trial and achieve adequate power to determine the effectiveness the peer specialist intervention for reducing suicide attempts. The additional site will be a 48-bed inpatient unit within the Henry Ford healthcare system, which was chosen in part because the study has already received institutional review board approval for the current Henry Ford recruitment site. By achieving our full study sample, we also propose to compare remote vs. in-person implementation of the intervention on measures of acceptability and suicidal ideation. Due to the COVID-19 pandemic, the PREVAIL intervention shifted from primarily in-person to primarily remote (phone or video) delivery with unclear effects. These analyses will provide important guidance for health system implementation of PREVAIL and other similar peer support interventions.