Adaptive intervention to prevent adolescent suicidal behavior following psychiatric hospitalization: A Sequential Multiple Assignment Randomized Trial

预防青少年精神病住院后自杀行为的适应性干预：一项序贯多重分配随机试验

• 批准号: 10272610
• 负责人: Ewa Karina Czyz
• 金额: $ 73.43万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-07 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10272610
• 关键词: 17 year old; Acute; Address; Adolescent; Age; Area; Cause of Death; Cellular Phone; Continuity of Patient Care; Emergency department visit; Environment; Event; Feeling suicidal; Funding; Goals; Health behavior outcomes; Healthcare Systems; Hospitalization; Hospitalized Adolescent; Hospitals; Inpatients; Interruption; Intervention; Link; Mediating; Motivation; National Institute of Mental Health; Outcome; Parents; Phase; Procedures; Psychiatric therapeutic procedure; Public Health; Randomized; Recurrence; Research; Resources; Risk; Safety; Self Efficacy; Sequential Multiple Assignment Randomized Trial; Services; Severities; Suicide; Suicide attempt; Suicide prevention; Surveys; Technology; Teenagers; Testing; Text; Text Messaging; Time; United States; Youth; acceptability and feasibility; adaptive intervention; adolescent suicide; adverse outcome; base; comparative efficacy; coping; cost; design; effective intervention; high risk; hospital readmission; ideation; improved; innovation; inpatient service; mobile computing; motivational enhancement therapy; multi-component intervention; new technology; novel; novel strategies; personalized intervention; prevent; primary outcome; reducing suicide; response; secondary outcome; sex; suicidal; suicidal adolescent; suicidal behavior; suicidal risk; suicide rate; treatment response; treatment strategy; trial design

ABSTRACT The increasing rates of suicide among adolescents is an urgent public health concern. In parallel, emergency department (ED) visits and psychiatric hospitalizations due to youth suicide risk have also been on the rise. Although psychiatric hospitalization provides critical stabilization, discharged adolescents remain at elevated risk for recurrent suicidal crises (e.g., suicide attempts, rehospitalizations). New approaches are urgently needed to alter risk trajectories and prevent suicidal behavior among adolescents transitioning from inpatient care. Bridging an adaptive intervention (AI) strategy—wherein type, intensity, and timing of treatment can be individualized to address suicidal adolescents’ changing and heterogenous treatment needs—together with mobile technology to reach adolescents during the high-risk post-discharge period, our goal is to identify an optimal AI for reducing youth suicidal behavior after inpatient care. We build on promising evidence from our recently completed NIMH-funded pilot sequential multiple assignment randomized trial (SMART) of a multi- component intervention comprised of: a Motivational Interview (MI)-enhanced safety plan delivered to adolescents and parents during hospitalization (MI-SP); post-discharge booster calls provided to youth and parents; and text-based support (Texts) delivered to adolescents daily for a month after discharge. In addition to feasibility and acceptability, the pilot SMART results suggested that certain intervention sequences improved key mechanisms of change (self-efficacy, safety plan use, coping) and were, preliminarily, associated with lower suicidal behavior 3 months after discharge. In this application, we propose to conduct a full-scale SMART to address the following specific aims: (1) Compare the AIs that begin with MI-SP alone or MI-SP plus Texts on the primary outcome of suicidal behavior (actual, interrupted, or aborted attempts) within 3 months post discharge and the two secondary outcomes of time-to-suicidal behavior and severity of suicidal ideation over 6 months; and (2) Determine the optimal sequence of intervention components by comparing four AIs embedded in the SMART on primary and secondary outcomes. Adolescents (N=300), ages 13-17, hospitalized due to suicidal ideation and/or attempt will be initially randomized to MI-SP alone or MI-SP with Texts. Based on adolescents’ responses to daily surveys, those classified as non-responders within 2 weeks post discharge will be re-randomized to added low-intensity booster calls (one call with adolescent and one call with parent) or high-intensity boosters (six calls with each). Secondary aims are to: (1) Identify moderators of initial intervention options and of augmentation strategies for non-responders; and (2) Examine whether mechanisms of change (self-efficacy, safety plan use, coping) mediate the impact of MI-SP plus Texts and that of high- intensity boosters. The proposed research will have significant public health impact by testing different sequences of continuity of care strategies within an innovative SMART design to identify an optimal technology-augmented AI targeting suicidal behavior reduction among youth transitioning from inpatient care.

抽象的 青少年自杀率的上升是一个紧迫的公共卫生问题。同时，紧急 由于青少年自杀风险而导致的急诊科就诊和精神科住院治疗也在增加。 尽管精神病院住院治疗可以提供关键的稳定，但出院的青少年仍然处于较高水平 反复出现自杀危机的风险（例如自杀未遂、再住院）。新方法刻不容缓 需要改变风险轨迹并防止青少年从住院过渡到自杀行为 关心。桥接适应性干预（AI）策略——其中治疗的类型、强度和时间可以是 个性化地解决自杀青少年不断变化和异质的治疗需求——连同 移动技术在出院后的高风险时期接触青少年，我们的目标是确定一种 减少青少年住院治疗后自杀行为的最佳人工智能。我们以我们的有希望的证据为基础 最近完成了 NIMH 资助的试点序贯多重分配随机试验 (SMART) 干预措施包括： 动机访谈 (MI) 强化安全计划 住院期间的青少年和家长 (MI-SP)；向青少年和青少年提供出院后的支持电话 父母;出院后一个月内每天向青少年提供基于文本的支持（文本）。此外 就可行性和可接受性而言，试点 SMART 结果表明某些干预顺序得到了改善 变革的关键机制（自我效能、安全计划的使用、应对），并且初步与 出院后 3 个月自杀行为减少。在此应用中，我们建议进行全面的 SMART 旨在实现以下具体目标： (1) 比较以单独 MI-SP 或 MI-SP 加开头的 AI 有关 3 个月内自杀行为主要结果（实际、中断或中止的尝试）的文本 出院后以及自杀行为时间和自杀意念严重程度的两个次要结果 超过6个月； (2) 通过比较四种人工智能来确定干预成分的最佳顺序 嵌入主要和次要结果的 SMART 中。住院青少年 (N=300)，年龄 13-17 岁 由于自杀意念和/或企图，最初将被随机分配到单独的 MI-SP 或带有文本的 MI-SP。基于 关于青少年对每日调查的反应，出院后 2 周内被归类为无反应者 将重新随机添加低强度的加强通话（一次与青少年通话，一次与家长通话）或 高强度助推器（每个助推器六次）。次要目标是： (1) 确定初始的调节者 针对无反应者的干预方案和增强策略； (2) 检查机制是否 变化的影响（自我效能、安全计划的使用、应对）调节 MI-SP 加文本和高 强度助推器。拟议的研究将通过测试不同的方法对公共健康产生重大影响 创新 SMART 设计中的护理连续性策略序列，以确定最佳方案 技术增强型人工智能旨在减少从住院护理过渡的青少年的自杀行为。