Project 3

项目3摘要 项目3的总体目标是推进预防自杀和自我伤害的科学和临床护理，并 加强知识，以实现我国减少自杀死亡和自杀企图的国家目标。22在 中心治疗模式的背景，“焦虑和抑郁的筛查和治疗”(STAND)，项目 3将STAND的临床目标扩展到减少自杀和自残风险，目标是提高STAND 有效性和效益，并为社区大学提供可扩展的自杀/自残预防模式。 认识到精神健康结果和获得循证护理方面的差异，我们将重点放在东洛杉矶 洛杉矶社区学院(ELAC)，这是洛杉矶一个多元化的低收入地区的社区大学网站。 使用签名项目样本(N=1000)和方法，项目3寻求：1)通过以下方式增强风险检测 开发/评估用于识别发病前出现的“SU/SH风险状态”指标的算法 预防自杀/自残(SU/SH)行为，并提供提供“及时”干预的机会 自杀/自残事件；2)评估STAND的有效性，并指定治疗级别/级别和 根据数据驱动的算法进行调整，与症状严重程度、自杀/自残后果进行比较； 以及3)加强自杀/自我伤害预防立场的有效性 技术增强型自杀预防干预(TE-SPI)，将干预组件与 在先前的研究中证明了好处。其中包括：安全规划；数字干预(BRITE应用程序)， 促进安全计划的使用、技能和希望；以及关怀联系人。TE-SPI将进行预先测试并进行调整，以适应 第一年和第二年的中心人口，提供关于安全性、可行性、可接受性和干预的数据 效果。在3-5年级，420名有需要的学生(三级或二级标准)将被随机分配到 TE-SPI PLUS支持通常的风险管理(URM)，或支持URM。我们检验了这一假设 与URM相比，TE-SPI组将显示：治疗参与度/接触者增加(即APP、STAND)； 更低的自杀/自残事件风险；更大程度的自杀严重性改善；更低的自杀/自我伤害水平 与伤害相关的不良事件(如住院、急诊)；以及增加治疗参与度导致 以改善自杀/自残结果。主要结果和次要结果分别为：自杀/自残 事件(包括自杀未遂、不明和非自杀性自残/NSSI)；以及顺序自杀意志量表 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.