Promoting Social Connection to Prevent Late-Life Suicide

促进社会联系以预防晚年自杀 老年人的自杀率很高，预测表明，随后的人群将迎来更高的自杀率。 rates.我们可以预期，在未来几十年中，老年人自杀死亡人数将增加。但有 没有基于证据的干预措施来预防晚年的自杀死亡，并且缺乏数据支持策略， 防止任何年龄段的自杀。社会脱节是一个有前途的干预目标，晚年自杀 预防，但目前尚不清楚是否针对社会联系是一种有效的策略，以防止自杀， 后来的生活。 这项R61/R33提案的目标，符合NIMH减少自杀和理解的优先事项， 机制，是为了测试是否行为干预-社会参与教练（S-ENG）-减少自杀 通过社会联系（目标机制）的晚年风险（临床结果）。我们建议分两个阶段 实验治疗学项目与多模式评估的客观和主观指标的社会 连接（通过智能手机评估）。R61是一项S-ENG的单臂试验（n=30），为期1周， 基线、8周和16周时基于智能手机的目标评估。R33是RCT（S-ENG与 eCAU; n=120），随访时间更长，以测试临床影响（20周）。受试者是孤独的老年人 在支持自杀意念的老年生活社区（SLC）中。研究条件为S-ENG（10个个体 培训课程）和加强SLC的日常护理（eCAU;接触SLC环境， 董事）。 R61阶段的第一个目标是测试目标参与度（社交联系）。我们假设S-ENG 将与四个社会联系指数的增加相关。我们的去/不去标准将决定我们是否 进入R33阶段：至少有两个社会联系指数必须证明具有临床意义 一个是客观，一个是主观。如果符合可以/不可以的标准，我们将实现两个目标， R33阶段。首先，在随机试验中确认目标参与。我们假设S-ENG（vs. eCAU） 将伴随着社会联系的增加。第二，检查临床和功能 降低自杀风险的指标。我们假设S-ENG（与eCAU相比）将与更大的 20周随访时自杀意念和生活质量的改善以及社会联系的改善 在16周时，将与自杀风险指数的降低相关。 本研究之后将进行确证性疗效试验。促进社会联系以防止自杀是一个不足- 研究但有希望的战略，以解决心理健康和福祉在以后的生活。

Promoting Social Connection to Prevent Late-Life Suicide Older adults have high rates of suicide and projections indicate subsequent cohorts will usher in even higher rates. We can expect an increase in suicide deaths among older adults in coming decades. However, there are no evidence-based interventions to prevent suicide deaths in later life, and scant data support strategies to prevent suicide deaths at any age. Social disconnection is a promising intervention target for late-life suicide prevention, but it is not known whether targeting social connection is an effective strategy to prevent suicide in later life. The objective of this R61/R33 proposal, in line with NIMH priorities of reducing suicide and understanding mechanisms, is to test whether a behavioral intervention—Social Engage Coaching (S-ENG)—reduces suicide risk in later life (clinical outcome) via social connection (target mechanism). We propose a two-phase experimental therapeutics project with multimodal assessment of objective and subjective indicators of social connection (via smartphone assessments). The R61 is a single-arm trial of S-ENG (n=30) with 1 week of smartphone-based target assessment at baseline, 8-weeks, and 16-weeks. The R33 is an RCT (S-ENG vs. eCAU; n=120) with longer duration follow-up to test clinical impact (20-weeks). Subjects are lonely older adults in Senior Living Communities (SLCs) who endorse suicide ideation. Study conditions are S-ENG (10 individual coaching sessions) and enhanced usual-care in SLCs (eCAU; exposure to SLC milieu with geriatrician medical directors). Our first aim for the R61 phase is to test target engagement (social connection). We hypothesize that S-ENG will be associated with increases in four indices of social connection. Our go/no-go criteria will determine if we move to the R33 phase: At least two indices of social connection must evidence clinically meaningful improvement—one objective and one subjective. If go/no-go criteria are met, we will address two aims for the R33 phase. First, to confirm target engagement in a randomized trial. We hypothesize that S-ENG (vs. eCAU) will be associated with greater increases in social connection. Second, to examine clinical and functional indices of reduced suicide risk. We hypothesize that S-ENG (vs. eCAU) will be associated with greater improvement in suicide ideation and quality of life at 20-week follow-up and improvement in social connection at 16-weeks will be associated with reduction in indices of suicide risk. A confirmatory efficacy trial will follow this study. Promoting social connection to prevent suicide is an under- studied but promising strategy to address mental health and well-being in later life.