Caring Texts: A Strength-based, Suicide Prevention Trial in 4 Native Communities

描述(由申请人提供)：高自杀率在美国印第安人和阿拉斯加原住民(AI/AN)年轻人中很普遍。最近的一项研究发现，北部平原和阿拉斯加的年轻AI/AN成年人的发病率是相同地区同龄白人的4倍多。建立社会关系是预防自杀的一个关键目标。一个经过验证的理论模型断言，属于一个群体是人类的基本需要。当这种需要因社会孤立或社会支持不足而受挫时，就会产生一种对死亡的渴望。AI/ANS中关于自杀预防的研究强调了与朋友、家人、关心他人的邻居和社区领导人建立联系的文化重要性。这些社区凝聚力的传统可以用来保护年轻的AI/AN成年人免受自杀念头和行为的影响。关怀接触是一项自杀预防计划，通过促进人际联系来补充标准护理。有自杀风险的人经常与医疗系统失去联系，也得不到后续护理。在最初的陈述后的一年里，关爱联系人会寻找这样的人来发送信息，表达关心、关心和兴趣。在一项随机对照试验中，这是唯一显示可以防止任何人群自杀的干预措施。作为试点赠款的一部分，我们与四个部落伙伴进行了近两年的合作，基于此，我们设计了一种在当地可行的、文化上合适的关怀接触干预措施，它将使用短信，这是年轻的AI/AN成年人的主要沟通方式。这项研究使用随机对照试验(RCT)在来自我们四个伙伴社区的1200名18-34岁的高危AI/AN中评估这种自杀预防方法。我们的具体目标是：1)比较常规护理(控制)和控制条件加关怀短信(干预)在减少自杀意念、自杀企图和与自杀相关的住院方面的有效性。2)评估社会连通性是短信关爱接触对自杀影响的中介因素。美国卫生局局长的国家自杀预防战略将与他人的联系确定为防止自杀的主要保护因素。53通过采用和传播关怀接触的方法，我们的研究将评估一种低成本、可持续的干预措施，以解决自杀的严重差异 年轻成人AI/ANS经历的风险。

DESCRIPTION (provided by applicant): High rates of suicide are endemic in American Indian and Alaska Native (AI/AN) young adults. A recent study found that rates for young AI/AN adults in the Northern Plains and in Alaska are more than 4 times higher than for Whites of the same age in the same regions. Building social connections is a key goal of suicide prevention. One validated theoretical model asserts that belonging to a group is a fundamental human need. When this need is thwarted by social isolation or inadequate social support, a desire for death emerges. Studies of suicide prevention in AI/ANs underscore the cultural importance of connection to friends, family, caring neighbors, and community leaders. These traditions of community cohesion can be leveraged to protect young AI/AN adults against suicidal ideation and behavior. Caring Contacts is a suicide prevention program that supplements standard care by promoting human connectedness. People at risk for suicide often lose contact with the healthcare system and receive no follow-up care. For 1 year after an initial presentation, Caring Contacts seeks out such individuals to send messages expressing care, concern, and interest. It is the only intervention shown to prevent suicide in any population in a randomized, controlled trial. Based on an almost two year collaborative process with four tribal partners as part of a pilot grant, we have designed a locally feasible, culturally appropriate Caring Contacts intervention that will use text messaging, the dominant communication method for young AI/AN adults. This study uses a randomized, controlled trial (RCT) to evaluate this approach to suicide prevention in 1,200 high-risk AI/ANs aged 18-34 from our four partner communities. Our Specific Aims are to: 1) Compare the effectiveness of usual care (control) to the control condition plus caring text messages (intervention) for reducing suicidal ideation, suicide attempts, and suicide- related hospitalizations. 2) Evaluate social connectedness as a mediating factor for the effect of Caring Contacts via text message on suicidality. The US Surgeon General's National Strategy for Suicide Prevention identifies connectedness to others as the primary protective factor against suicidality.53 By adapting and disseminating the Caring Contacts approach, which has demonstrated effectiveness in non-Native populations, our study will evaluate a low-cost, sustainable intervention for addressing the profound disparity of suicide risk experienced by young adult AI/ANs.