Feasibility, acceptability, and preliminary effectiveness of a cognitive-behavioral suicide prevention-focused intervention tailored to adults diagnosed with schizophrenia spectrum disorders2019

针对诊断为精神分裂症谱系障碍的成年人量身定制的以认知行为自杀预防为重点的干预措施的可行性、可接受性和初步有效性2019

• 批准号: 10038351
• 负责人: Lindsay Ann Bornheimer
• 金额: $ 70.2万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-15 至 2024-08-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10038351
• 关键词: Adult; Behavioral; Cause of Death; Cessation of life; Client; Clinical; Clinical Treatment; Cognitive; Cognitive Therapy; Communities; Community Mental Health Services; Community Practice; County; Data; Development; Diagnosis; Effectiveness; Effectiveness of Interventions; Emergency Situation; Enrollment; Evidence based intervention; Evidence based treatment; Feedback; Feeling hopeless; Feeling suicidal; Future; General Population; Goals; Hallucinations; Hybrids; Intervention; Interview; Length; Mediator of activation protein; Mental Depression; Mental Health; Modification; Monitor; National Institute of Mental Health; Outcome; Pain; Play; Population; Preventive Intervention; Process; Protocols documentation; Provider; Psychotic Disorders; Public Health; RHOA gene; Randomized; Research; Risk; Risk Estimate; Role; Sampling; Schizophrenia; Services; Site; Social support; Strategic Planning; Suicide; Suicide attempt; Suicide prevention; Symptoms; Technology; Testing; Text; Time; Training; Vulnerable Populations; Work; cognitive process; coping; depressive symptoms; design; effectiveness trial; epidemiologic data; evidence base; experience; follow-up; hospital services; implementation science; improved; information processing; innovation; novel; pilot trial; premature; primary outcome; programs; randomized trial; reducing suicide; response; screening; service intervention; suicidal; suicidal risk; suicide model; suicide rate; theories; usability

Suicide is among the leading causes of death for adults with schizophrenia, with risk estimates being over eight times greater than among the general population. While research has largely focused on depression and hopelessness, there is growing support for the role that symptoms of psychosis (e.g. hallucinations) play in suicide risk. Further, this high suicide rate continues to be a major public health concern given the paucity of evidence-based interventions to reduce suicidality in this population. We propose to modify and evaluate the acceptability and preliminary effectiveness of Cognitive Behavioral Suicide Prevention for psychosis (CBSPp), a promising intervention requiring protocol and implementation modifications to increase its utility in community mental health (CMH). The following modifications will be pursued given feedback from clients and providers: 1) modify and shorten treatment; 2) develop a hybrid technology-assisted provider training; and, 3) develop a between-session client text booster. Further innovations will be informed by engagement with stakeholders in CMH to review and gain feedback on the protocol. Accordingly, the study aims to: 1) modify CBSPp for clients with schizophrenia spectrum and other psychotic disorders (SSPD) receiving CMH services, and 2) evaluate the feasibility and preliminary effectiveness of modified CBSPp in a randomized trial in comparison to services-as- usual (SAU). Aim 1 will involve: 1) the development of a hybrid technology-assisted CBSPp provider training, text boosters; 2) in-depth qualitative interviews to evaluate CBSPp materials and delivery protocol with stakeholders, including 15 adults with SSPD and suicidal ideation and/or attempt (SI/A) within 3 months of screening and 10 CMH staff, providers, directors, and leaders; 3) input from an expert panel of scholars prior to modifications for CBSPp protocol and delivery, hybrid provider training, and text booster; 4) an open pilot trial with 8 clients and 2 providers; 5) qualitative interviews with CBSPp delivery providers (n=2) and 5 staff, leaders, and directors in CMH to explore provider experiences and organizational impact of CBSPp implementation at the research site (Washtenaw County Community Mental Health; WCCMH); and, 6) final modifications prior to the Aim 2 trial. Aim 2 will involve a trial to test preliminary effectiveness and implementation of modified CBSPp (versus services as usual; SAU) among adults with SSPD and SI/SA within 3 months of screening (n=60). A 4- wave design will include quantitative assessments at baseline (T1), mid-test (T2), post-test (T3), and follow-up (T4) with in-depth qualitative interviews at T4 for a random sample of adults in the CBSPp group (n=10). Providers (n=8) will be trained to deliver CBSPp and be assessed T1-T4 to evaluate the implementation process, including in-depth qualitative interviews at T4. We will monitor fidelity, acceptability, usability, and feasibility of the modified CBSPp. This proposal is in response to RFA-MH-18-706, Pilot Effectiveness Trials for Treatment, Preventative and Services Interventions, and follows NIMH’s strategic plan to develop ways to tailor existing and new interventions to optimize outcomes (3.2) and test interventions for effectiveness in community practice (3.3).

自杀是精神分裂症成年人死亡的主要原因之一，风险估计超过八个 比普通人群大。研究主要集中在抑郁症和 绝望，对精神病象征（例如幻觉）的作用的支持越来越多 自杀风险。此外，由于缺乏，这种高自杀率仍然是一个主要的公共健康问题 基于证据的干预措施，以减少该人群的自杀性。我们建议修改和评估 认知行为自杀预防精神病的可接受性和初步有效性（CBSPP），一个 有希望的干预措施需要协议和实施修改以增加其在社区中的效用 心理健康（CMH）。将对客户和提供商的反馈进行以下修改：1） 修改和缩短治疗； 2）开发混合技术辅助提供商培训； 3）开发一个 会议之间的客户文本助推器。通过与利益相关者的参与，将向进一步的创新信息 CMH审查并获得有关该协议的反馈。根据该研究的目的：1）为客户修改CBSPP 具有精神分裂症谱和其他精神病障碍（SSPD）接受CMH服务，2）评估 与服务相比 通常（Sau）。 AIM 1将涉及：1）开发混合技术辅助的CBSPP提供商培训， 文字助推器； 2）深入的定性访谈，以评估CBSPP的材料和交付协议 利益相关者，包括15名具有SSPD和自杀想法和/或尝试（SI/A）的成年人 筛查和10CMH的工作人员，提供者，董事和领导者； 3）先前的专家小组的输入 修改CBSPP协议和交付，混合提供商培训和文本助推器； 4）开放试点审判 有8个客户和2个提供商； 5）与CBSPP送货提供商（n = 2）和5名员工，领导者的定性访谈， 以及CMH中的董事，以探索CBSPP实施提供者的经验和组织影响 研究地点（Washtenaw县社区心理健康； WCCMH）； 6）最终修改之前 目标2试验。 AIM 2将涉及测试初步有效性和实施改良CBSPP的试验 （与往常一样的服务相对于服务；一个4- 波浪设计将包括基线（T1），中测（T2），测试后（T3）和随访时的定量评估 （T4）在CBSPP组中随机样本的T4进行了深入的定性访谈（n = 10）。 提供者（n = 8）将接受培训以交付CBSPP并评估T1-T4以评估实施过程， 包括T4的深入定性访谈。我们将监控忠诚度，可接受性，可用性和可行性 修改后的CBSPP。该建议是对RFA-MH-18-706的回应，即用于治疗的试验有效性试验， 预防和服务干预措施，并遵循NIMH的战略计划，以制定量身定制现有和的方法 新的干预措施以优化结果（3.2）和测试干预措施，以实现社区实践的有效性（3.3）。

项目成果

A cognitive-behavioral suicide prevention treatment for adults with schizophrenia spectrum disorders in community mental health: Preliminary findings of an open pilot study.

对社区心理健康中患有精神分裂症谱系障碍的成年人进行认知行为自杀预防治疗：一项开放试点研究的初步结果。

• DOI: 10.1080/15332985.2023.2186736
• 发表时间: 2023
• 期刊: Social work in mental health
• 影响因子: 1.1
• 作者: Bornheimer,LindsayA;Verdugo,JuliannLi;Krasnick,Julie;Jeffers,Nakea;Storey,Frank;King,CherylA;Taylor,StephanF;Florence,Timothy;Himle,JosephA
• 通讯作者: Himle,JosephA

Mental health provider perspectives of the COVID-19 pandemic impact on service delivery: a focus on challenges in remote engagement, suicide risk assessment, and treatment of psychosis.

• DOI: 10.1186/s12913-022-08106-y
• 发表时间: 2022-05-31
• 期刊: BMC health services research
• 影响因子: 2.8

Modifying a cognitive behavioral suicide prevention treatment for adults with schizophrenia spectrum disorders in community mental health.

• DOI: 10.1016/j.psychres.2022.114505
• 发表时间: 2022-05
• 期刊: PSYCHIATRY RESEARCH
• 影响因子: 11.3
• 作者: Bornheimer, Lindsay A.;Li Verdugo, Juliann;Holzworth, Joshua;Im, Vitalis;Smith, Fonda N.;Sliwa, Hannah;Taylor, Stephan F.;King, Cheryl A.;Florence, Timothy;Tarrier, Nicholas;Himle, Joseph A.
• 通讯作者: Himle, Joseph A.