Reducing suicide risk among aging caregivers of persons with AD/ADRD: Adapting, implementing, and evaluating Dialectical Behavior Therapy skills training interventions.

降低 AD/ADRD 患者老年护理人员的自杀风险：调整、实施和评估辩证行为治疗技能培训干预措施。

• 批准号: 10730708
• 负责人: Sean M Mitchell
• 金额: $ 45.87万
• 依托单位: TEXAS TECH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2026-08-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10730708
• 关键词: Address; Adult; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Area; Biological Markers; Caregiver Burden; Caregivers; Chronic Disease; Data; Day Care; Dialectical behavior therapy; Distress; Educational Intervention; Effectiveness; Elderly; Enrollment; Ensure; Environment; Evidence based intervention; Evidence based treatment; Exhibits; Family; Feeling suicidal; Focus Groups; Functional disorder; General Population; Goals; Health; Hour; Individual; Inflammation; Interdisciplinary Study; Intervention; Life; Manuals; Methodology; Modality; Monitor; Outcome; Outcome Study; Participant; Patient Recruitments; Patient Self-Report; Patients; Persons; Physiological; Prevention approach; Protocols documentation; Public Health; Reporting; Research; Resources; Risk; Risk Assessment; Risk Factors; Sampling; Site; Stress; Students; Suicide; Suicide prevention; Surveys; Time; Universities; Work; acceptability and feasibility; caregiving; coping; cost effective; distress tolerance; emotion regulation; experience; follow-up; group intervention; heart rate variability; help-seeking behavior; high risk population; improved; inflammatory marker; informal caregiver; innovation; middle age; mindfulness; neglect; novel; post intervention; psychologic; psychosocial; reducing suicide; response; screening; skills; skills training; suicidal; suicidal risk; suicide rate

ABSTRACT Informal caregivers (ICs; non-professional caregivers) of persons with Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD) experience caregiving-related distress and have about 650% higher rates of suicide ideation (SI; 32.32%) compared to the general population (4.3%). Dialectical Behavior Therapy (DBT), an evidence-based intervention for suicide, addresses multiple areas of psychosocial functioning. Standard DBT is often too resource-intensive (6 months to 1 year of weekly individual sessions and 1.5-2.5- hour weekly skills training group sessions) and is not tailored to ICs of persons with AD/ADRD with SI, creating a significant barrier to SI treatment. We will develop, implement, and evaluate an adapted DBT skills training groups tailored to the unique experiences and needs of ICs of persons with AD/ADRD to reduce suicide-re- lated outcomes most effectively. Our specific aims are: (1) Adapt DBT skills groups for ICs (of persons with AD/ADRD) endorsing direct or indirect SI (directly stated SI vs. indirect indicators of SI) to ensure it applies to direct and indirect SI and considers SI underreporting; (2) Evaluate the feasibility, acceptability, and fidelity of the adapted DBT skills groups in this sample; (3) Assess preliminary effectiveness indicators of the adapted DBT skills groups. For Aim 1, a panel of experts and two stakeholders (Garrison Institute of Aging (GIA) staff; IC of a person with AD/ADRD), will inform the adaptation of DBT skills training to ICs of persons with AD/ADRD and shorten to 16 weekly, 1-hour skills groups sessions, over 4 months. For Aims 2 and 3, we will implement the adapted DBT skills training groups among ICs of persons with AD/ADRD with direct/indirect SI at screening while providing respite, all at GIA. We will collect relevant demographic data from ICs and IC-re- ported data about the person with AD/ADRD. Over 18 time points (baseline, following weekly DBT sessions, follow-up), participants will complete self-report assessments targeting DBT fidelity/acceptably, SI (direct and indirect), and suicide risk correlates. We will also record DBT session to monitor fidelity. We will track partici- pant recruitment, group attendance, retention as feasibility metrics. We will also use innovative methodology by collecting inflammation biomarkers and heart rate variability data as an indirect SI assessment. Lastly, we will conduct IC focus groups after the intervention for additional qualitative acceptability and feasibility data. We will also survey GIA site staff to evaluate their perceived acceptability and feasibility of the intervention at GIA. Our hypotheses are that 1) our adapted DBT skills group will be feasible, acceptable, and maintain DBT fidelity, and 2) SI (direct and indirect), suicide risk factors, and inflammation will decrease, and heart rate variability will increase post intervention. Our expected outcomes are to have a scalable DBT group intervention for ICs of persons with ADRD, indications of feasibility and acceptability, and preliminary effectiveness indicators. This work will provide a life-saving suicide prevention approach for ICs of persons with AD/ADRD, provide students with multidisciplinary research experiences, and significantly strengthen our university research environment.

摘要 阿尔茨海默病和阿尔茨海默病患者的非正式照顾者（IC;非专业照顾者） 疾病相关性痴呆（AD/ADRD）经历与抑郁相关的痛苦， 自杀意念率（SI; 32.32%）与一般人群（4.3%）相比。辩证行为疗法 (DBT)是一种基于证据的自杀干预措施，涉及心理社会功能的多个领域。 标准的DBT通常过于资源密集（6个月至1年的每周单独会议和1.5-2.5-2.5个月）。 小时的每周技能培训小组会议），并且不适合患有AD/ADRD伴SI的人的IC， 这是SI治疗的一个重大障碍。我们将开发，实施和评估适应DBT技能培训 根据AD/ADRD患者的独特经历和需要量身定制的团体，以减少自杀率 最有效的结果。我们的具体目标是：（1）调整DBT技能组，使其适用于（具有 AD/ADRD）认可直接或间接SI（直接陈述的SI与SI的间接指标），以确保其适用于 直接和间接的SI，并考虑SI漏报;（2）评估的可行性，可接受性，和保真度 （3）评估适应性DBT技能组的初步有效性指标; DBT技能组。对于目标1，一个专家小组和两个利益攸关方（加里森老龄问题研究所工作人员; AD/ADRD患者的IC），将告知DBT技能培训适应以下患者的IC： AD/ADRD，并缩短为16个每周，1小时的技能小组会议，超过4个月。对于目标2和3，我们将 在患有AD/ADRD的直接/间接SI患者的IC中实施适应性DBT技能培训组 都在GIA接受检查我们将从IC和IC收集相关人口统计数据， 关于AD/ADRD患者的移植数据。超过18个时间点（基线，每周DBT会话后， 随访），参与者将完成自我报告评估，目标是DBT保真度/可接受，SI（直接和 间接），与自杀风险相关。我们还将记录DBT会话以监控保真度。我们会追踪- Pant招募、组出勤率、保留率作为可行性度量。我们还将采用创新的方法， 收集炎症生物标志物和心率变异性数据作为间接SI评估。最后，我们将 在干预后进行IC焦点小组，以获得更多定性的可接受性和可行性数据。我们将 还对GIA现场工作人员进行调查，以评估他们对GIA干预措施的可接受性和可行性的看法。我们 假设是：1）我们的适应DBT技能组将是可行的，可接受的，并保持DBT的保真度， 和2）SI（直接和间接），自杀危险因素和炎症将减少，心率变异性将 增加后干预。我们的预期成果是为以下IC提供可扩展的DBT组干预： ADRD患者、可行性和可接受性的迹象以及初步有效性指标。这 这项工作将为患有AD/ADRD的IC提供挽救生命的预防自杀方法，为学生提供 拥有多学科研究经验，并显着加强我们的大学研究环境。