Promoting Social Connection to Prevent Late-Life Suicide

促进社会联系，预防晚年自杀 老年人的自杀率很高，预测表明，随后的队列将迎来更高的自杀率 费率。我们可以预计，在未来几十年，老年人的自杀死亡人数将会增加。然而，有一些 没有基于证据的干预措施来预防晚年的自杀死亡，也缺乏数据支持战略来 防止任何年龄的自杀死亡。社会脱节是老年自杀的一个有希望的干预目标 预防，但尚不清楚以社会关系为目标是否是预防自杀的有效策略 以后的生活。 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，是为了测试一种行为干预--社交参与教练(S-ENG)--是否减少自杀 通过社会关系(目标机制)在晚年生活中的风险(临床结果)。我们建议分两个阶段 多模式评估社会主客观指标的实验治疗学项目 连接(通过智能手机评估)。R61是S-ENG(n=30)的单臂试验，为期1周 在基线、8周和16周进行基于智能手机的目标评估。R33是RCT(S-ENG与 ECAU；n=120)，持续时间更长的随访以测试临床影响(20周)。受试者是孤独的老年人 在老年生活社区(SLC)中支持自杀想法的人。学习条件为S-英(10人 培训课程)和加强SLC的日常护理(eCAU；与老年医生一起暴露在SLC环境中 董事)。 我们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-英 将与社会联系的四个指数的增加有关。我们的通过/不通过标准将决定我们是否 进入R33阶段：至少有两项社会关系指数必须证明具有临床意义 改进--一个客观和一个主观。如果满足去/不去的标准，我们将解决两个目标 R33期。首先，在随机试验中确认目标参与。我们假设S(vs.eCAU) 将与社会关系的更大增长相关联。第二，检查临床和功能 自杀风险降低的指标。我们假设S-英(vs.eCAU)将与更大的 20周随访中自杀意念和生活质量的改善以及社会关系的改善 16周将与自杀风险指数的降低相关。 在这项研究之后，将进行一项验证性疗效试验。促进社会联系以防止自杀是一种不充分的 研究但前景看好的战略，以解决心理健康和幸福的晚年生活。

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.