Promoting Social Connection to Prevent Late-Life Suicide

促进社会联系以防止晚年自杀

• 批准号: 10570717
• 负责人: Kimberly Allison Van Orden
• 金额: $ 63.87万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10570717
• 关键词: Address; Age; Behavior; Behavior Therapy; Cellular Phone; Cessation of life; Clinical; Data; Depressive disorder; Dimensions; Disease; Ecological momentary assessment; Elderly; Elements; Emotional; Evidence based intervention; Exposure to; Feeling suicidal; Firearms; Goals; Health; Home; Individual; Intervention; Intervention Studies; Investigational Therapies; Laboratories; Link; Loneliness; Measures; Mental Depression; Mental Health; Modeling; National Institute of Mental Health; Outcome; Patient Self-Report; Personal Satisfaction; Phase; Physician Executives; Population; Protocols documentation; Provider; Quality of life; Risk Factors; Severities; Social Conditions; Social Planning; Social isolation; Standardization; Suicide; Suicide prevention; Testing; Thinking; Time; United States National Institutes of Health; arm; cohort; community living; confirmatory trial; disability; efficacy trial; experience; follow-up; improved; in vivo; indexing; multimodality; peer; prevent; randomized trial; reducing suicide; satisfaction; social; social engagement; suicidal morbidity; suicidal risk; suicide rate; treatment as usual

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.

促进社会联系以防止晚年自杀 老年人的自杀率很高，预测表明后续群体的自杀率将会更高 费率。我们预计未来几十年老年人自杀死亡人数将会增加。然而，有 没有基于证据的干预措施来预防晚年自杀死亡，也缺乏数据支持策略 防止任何年龄段的自杀死亡。社交脱节是晚年自杀的一个有希望的干预目标 预防，但目前尚不清楚以社会联系为目标是否是预防自杀的有效策略 以后的生活。 R61/R33 提案的目标符合 NIMH 减少自杀和理解的优先事项 机制，是为了测试行为干预——社交参与辅导（S-ENG）——是否可以减少自杀 通过社会联系（目标机制）带来晚年风险（临床结果）。我们建议分两阶段 对社会客观和主观指标进行多模式评估的实验治疗项目 连接（通过智能手机评估）。 R61 是 S-ENG 的单臂试验（n=30），为期 1 周 基于智能手机的基线、8 周和 16 周目标评估。 R33 是一项 RCT（S-ENG 与 S-ENG） 电子大学； n=120）并进行较长时间的随访以测试临床影响（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。学习条件为S-ENG（10人 辅导课程）和加强 SLC 的常规护理（eCAU；与老年医学专家一起接触 SLC 环境） 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-ENG 将与四个社会联系指数的增加有关。我们的通过/不通过标准将决定我们是否 进入 R33 阶段：至少有两个社会关系指标必须证明具有临床意义 改进——一项客观，一项主观。如果满足通过/不通过标准，我们将实现以下两个目标： R33相。首先，在随机试验中确认目标参与度。我们假设 S-ENG（与 eCAU） 将与社会联系的更大增加相关。其次，检查临床和功能 自杀风险降低的指数。我们假设 S-ENG（相对于 eCAU）将与更大的相关性相关。 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 周后，自杀风险指数会降低。 这项研究之后将进行验证性疗效试验。促进社会联系以预防自杀是一个不足 研究过但有希望的解决晚年心理健康和福祉的策略。