Project 3

项目3 项目3的总体目标是推进预防自杀和自残的科学和临床护理， 加强知识，以实现我们减少自杀死亡和自杀的国家目标。 中心治疗模式的背景下，“焦虑和抑郁症的筛查和治疗”（STAND），项目 3扩展了STAND的临床目标，以降低自杀和自我伤害风险， 有效性和益处，并为社区学院提供可扩展的自杀/自我伤害预防模型。 认识到心理健康结果和循证护理的差异，我们专注于东洛杉矶 洛杉矶社区学院（ELAC），一所社区学院，位于洛杉矶一个多元化的低收入地区。 使用签名项目样本（N=1000）和方法，项目3旨在：1）通过以下方式加强风险检测 开发/评估算法，用于识别发病前出现的“SU/SH风险状态”指标 自杀/自我伤害（SU/SH）行为，并提供机会提供“及时”干预，以防止 自杀/自我伤害事件; 2）评价STAND与分配的治疗等级/水平的有效性， 根据数据驱动的算法，与症状严重程度相比，根据自杀/自我伤害结果进行调整; 以及3）通过在STAND中增加 技术增强的自杀预防干预（TE-SPI），将干预成分与 在先前的研究中证明了这些好处。这些措施包括：安全规划;数字干预（BRITE应用程序）， 提示安全计划的使用、技能和希望;以及关怀联系人。将对TE-SPI进行预测试和调整， 第1年和第2年的中心人群，提供安全性、可行性、可接受性和干预性数据 方面的影响.在3-5年级，420名学生根据需要（STAND Tiers III或II）被随机分配到 TE-SPI加STAND与商业风险管理（URM），或STAND与URM。我们检验了一个假设， 相对于URM，TE-SPI组将显示：增加的治疗参与/联系（即app、STAND）; 自杀/自我伤害事件的风险较低;自杀严重程度改善较大;自杀/自我伤害水平较低， 伤害相关不良事件（例如住院、艾德访视）;以及治疗参与度增加导致 改善自杀/自残的结果。主要和次要结局分别为：自杀/自残 事件（包括自杀企图、不明确和非自杀性自我伤害/NSSI）;以及顺序自杀量表， 无、意念、意图/计划、自杀行为、自杀企图的类别。

Project 3 Abstract The overall Project 3 goal is to advance science and clinical care for preventing suicide and self-harm and strengthen knowledge for reaching our national objectives of reducing suicide deaths and attempts.22 Within the context of the Center treatment model, “Screening and Treatment for Anxiety and Depression” (STAND), Project 3 extends the clinical targets of STAND to reducing suicide and self-harm risk with the goals of enhancing STAND effectiveness and benefits, and offering a scalable suicide/self-harm prevention model for community colleges. Recognizing disparities in mental health outcomes and access to evidence-based care, we focus on East Los Angeles Community College (ELAC), a community college site in a diverse, low-income area in Los Angeles. Using the Signature Project sample (N=1000) and methods, Project 3 seeks to: 1) enhance risk detection through developing/evaluating algorithms for identifying indicators of “SU/SH risk states” that emerge prior to the onset of suicidal/self-harm (SU/SH) behavior, and provide opportunities to deliver “just-in-time” interventions to prevent suicidal/self-harm episodes; 2) evaluate the effectiveness of STAND with treatment tier/level assigned and adapted based on data-driven algorithms, as compared to symptom severity, on suicide/self-harm outcomes; and 3) enhance the effectiveness of STAND for suicide/self-harm prevention by augmenting STAND with a technology-enhanced suicide prevention intervention (TE-SPI) that combines intervention components with demonstrated benefits in prior research. These include: safety planning; a digital intervention (BRITE app) that prompts safety plan use, skills, and hope; and caring contacts. The TE-SPI will be pre-tested and adapted for the Center population during Years 1 & 2, providing data on safety, feasibility, acceptability, and intervention effects. In Years 3-5, 420 students selected for need (STAND Tiers III or II) will be randomly assigned to either the TE-SPI plus STAND with Usual Risk Management (URM), or STAND with URM. We test the hypothesis that the TE-SPI group, relative to URM, will show: increased treatment engagement/contacts (i.e. app, STAND); lower risk of suicide/self-harm events; greater improvement in severity of suicidality; lower levels of suicide/self- harm related adverse events (e.g. hospitalizations, ED visits); and that increased treatment engagement leads to improved suicide/self-harm outcomes. Primary and secondary outcomes respectively are: suicide/self-harm events (including suicide attempts, unclear and nonsuicidal self-harm/NSSI); and an ordinal suicidality scale with categories of none, ideation, intent/plan, suicidal behavior, suicide attempts.