Shifting Suicide Prevention Paradigms: Looking Beyond Clinical Settings

改变自杀预防范式：超越临床环境

• 批准号: 10245784
• 负责人: John Rudolph Blosnich
• 金额: $ 143.56万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10245784
• 关键词: Autopsy; COVID-19 pandemic; Cessation of life; Client; Clinical; Coupled; Data; Detection; Distress; Divorce; Employee; Environment; Epidemic; Family; Feeling suicidal; Financial Hardship; Foreclosure; Funding Mechanisms; Gap Junctions; Goals; Health; Health Sciences; Healthcare; Individual; Industry; Intervention; Interview; Intuition; Job loss; Knowledge; Laws; Legal; Life; Medical Care Costs; Mental Health; Methodology; Nature; Occupational; Persons; Prevention; Prevention Research; Prevention strategy; Production; Productivity; Psychopathology; Public Health; Research; Research Personnel; Risk; Services; Social Environment; Suicide; Suicide attempt; Suicide prevention; Surveys; Testing; Time; Training; Unemployment; Work; experience; housing instability; novel; novel strategies; preventive intervention; psychologic; public health research; social; social determinants; social integration; stem; suicidal; suicidal risk

Project Summary: Shifting Suicide Prevention Paradigms: Looking Beyond Clinical Settings Every 10 minutes one person dies by suicide in the US, a result of a public health epidemic that has increased over the last 15 years and incurred over $70 billion in medical costs and lost productivity. A common lamentation in the wake of suicide is, “If we had only known how bad things were.” A crucial scientific gap in suicide prevention stems from the majority of suicide research relying on individual psychopathology, largely overlooking meaningful constellations of risk in a broader context of social environmental life disruptions that commonly precede suicide. Job loss, financial strain, divorce, legal problems, housing instability – these life disruptions can be semaphores of despair that are misinterpreted as coincidental rather than causal; thus overlooked as points for timely detection and intervention. I propose a paradigm shift in suicide research by prioritizing social determinants to develop public health research and prevention through broad, but strategic, partnerships with industries outside of mental health and health care, including the specific industries of family law, mortgage foreclosure, and unemployment services. This proposal uses a two- pronged approach that ventures beyond traditional funding mechanisms by challenging what we typically consider to be “health” vs. “non-health”-related suicide prevention research and intervention. First, by taking the tested methodology of psychological autopsy and reinventing it as a social autopsy, we will dive deeply both into the nature of life disruptions that often precede suicide and the contacts with non-medical services that a suicide decedent may have made prior to their death. Second, by surveying and interviewing employees of industries that commonly deal with life disruptions (i.e., divorce, mortgage foreclosure, and job loss), we will explore their experiences with suicidal clients, such as occupational wisdom and intuition around warning signs among clients, training around suicide prevention, knowledge about suicide, and approaches they may have used when working with clients in distress. Seeking unconventional upstream strategies to identify and reach people at risk for suicide is all the more urgent against the backdrop of the COVID-19 pandemic, which created historic job loss, relationship strain, and increased potential of mortgage foreclosures. As a researcher trained in public health sciences, I investigate the social production of health problems, exemplified in my focus of how social determinants contribute to poor mental health, suicidal ideation, and suicide attempt. My perspective, coupled with extensive experience in survey data research and efforts in training medicolegal death investigators, uniquely qualify me to successfully implement these novel approaches to change suicide risk detection and prevention. True integration of social determinants into suicide prevention research requires rethinking the problem of suicide as solely a clinical mental health problem requiring clinical solutions, to suicide as a problem at a social and clinical nexus, thus necessitating both social and clinical solutions.

项目摘要：改变自杀预防模式：超越临床环境 在美国，每10分钟就有一人死于自杀，这是公共卫生流行病增加的结果。 在过去的15年里，医疗费用和生产力损失超过700亿美元。一个共同 自杀后的哀叹是，“如果我们知道事情有多糟糕。”一个关键的科学空白， 自杀预防源于大多数自杀研究依赖于个体精神病理学， 忽视了在社会环境生活中断的更广泛背景下有意义的风险组合， 通常在自杀之前。失业，经济紧张，离婚，法律的问题，住房不稳定-这些生活 中断可能是绝望的信号，被误解为巧合，而不是因果关系;因此， 被忽视的及时发现和干预的要点。我建议改变自杀研究的模式， 优先考虑社会决定因素，通过广泛的、但 与精神卫生和医疗保健以外的行业建立战略伙伴关系，包括具体的 家庭法、抵押品赎回权和失业服务行业。该提案使用了两个- 一种超越传统筹资机制的多管齐下的方法， 被认为是“健康”与“非健康”相关的自杀预防研究和干预。首先，通过采取 经过检验的心理解剖方法论，并将其重新改造为社会解剖，我们将深入探讨 既包括自杀前生活中断的性质，也包括与非医疗服务机构的接触， 自杀死者在死前可能做过的事其次，通过调查和采访员工， 通常处理生活中断的行业（即，离婚、抵押品赎回权丧失和失业），我们将 探索他们与自杀客户的经验，例如职业智慧和对警告信号的直觉 在客户中，围绕自杀预防，自杀知识以及他们可能采取的方法进行培训 在与处于困境中的客户合作时使用。寻求非传统的上游战略，以确定和达到 在COVID-19大流行的背景下，有自杀风险的人更加紧迫， 历史性的失业，关系紧张，抵押品赎回权丧失的可能性增加。作为一名受过训练的研究人员， 在公共卫生科学中，我调查了健康问题的社会生产，例如我的重点是如何 社会因素导致心理健康状况不佳、自杀意念和自杀企图。我的观点， 再加上在调查数据研究方面的丰富经验和在法医学死亡培训方面的努力， 研究人员，唯一使我有资格成功实施这些新方法来改变自杀风险 检测和预防。真正将社会决定因素纳入自杀预防研究需要 重新思考自杀问题，将其仅仅视为一个需要临床解决方案的临床心理健康问题， 自杀是一个社会和临床问题，因此需要社会和临床解决方案。