Parent-adolescent informant discrepancies: Predicting suicide risk and treatment outcomes

项目摘要 自杀是美国青少年死亡的第二大原因。研究表明 自杀意念的发作通常出现在青春期早期，这些人大约是12倍 比没有自杀倾向的同龄人更有可能在中年时表现出自杀行为， 青春期是干预的关键发展时期。然而，这些自杀死亡的诱因（即， 自杀念头和行为）仍然难以预测和治疗。 包括父母的报告和青少年的自我报告，以确定哪些人需要干预， 检查治疗反应。从历史上看，这些评估一直被解释为基于高度 趋同的父母-青少年报告，或一个举报人的报告优先于另一个。那里 在如何最好地解释和利用不一致的举报人报告方面，仍然存在一个关键的知识差距。 几十年来在青少年精神病理学的研究表明，多信息不一致的报告模式（DRPs） 不等同于评估不佳，但可能表明有临床意义的信息。本 研究中，我们从共同发起人德洛斯雷耶斯的操作三合会模型，一套原则，阐明了 聚合和差异报告的功能，以检查跨两种情况下的多线人DRP。追求 在目标1中，我们将首先通过从完成的“评估”中提取数据来检查非治疗背景 研究'的特点基线报告，从父母青少年的二人组（n=96二人组）的自我伤害的想法 和行为访谈-修订版（R15 MH 113076; PI/主要申办者Cha）。我们将测试基线是否 关于社区青少年自杀想法和行为的父母-青少年DRPs预测了他们的自杀行为。 未来的自杀意念发生在3个月和6个月后。为了实现目标2，我们将研究一种治疗方法， 通过从正在进行的随机对照试验中提取数据（即，“治疗研究”）， 哥伦比亚自杀严重程度评定量表中父母-青少年二对（n=100对）的治疗报告 （R 01 MH 123556; MPI/共同申办方Yen）。我们将测试治疗前父母-青少年的DRP是否 住院青少年的自杀意念和行为可预测其治疗后的自杀意念， 行为，以及这些影响是否受到治疗分配（主动“提高技能 积极的干预与加强治疗作为治疗）。多项式回归和响应面 分析将被用来探测的方向和程度的父母-青少年DRPs（目标1-2）。与 测试多信息DRPs是否预测青少年在治疗和非治疗期间的未来风险的意图 治疗设置，这项工作的长期目标是最大限度地提高信息的预后价值， 容易收集，作为青年标准心理健康评估的一部分。

PROJECT SUMMARY Suicide is the 2nd leading cause of death among adolescents in the United States. Research suggests that the onset of suicidal ideation usually arises in early adolescence and these individuals are approximately 12 times more likely than their non-suicidal peers to exhibit suicidal behavior by middle adulthood, highlighting adolescence as a key developmental period for intervention. Yet, these precipitants of suicide death (i.e., suicidal thoughts and behaviors) remain difficult to predict and treat. Comprehensive assessments often include reports from parents and self-reports from adolescents to identify those in need of intervention and examine treatment responses. Historically, these assessments have been interpreted based on highly convergent parent-adolescent reports, or the prioritization of one informants' report over another. There remains a critical knowledge gap around how to best interpret and utilize inconsistent informant reports. Decades of research in youth psychopathology suggest multi-informant discrepant reporting patterns (DRPs) are not synonymous with poor assessment, but may indicate clinically meaningful information. In the present study, we draw from Co-Sponsor De Los Reyes' Operations Triad Model, a set of principles that elucidate the function of converging and discrepant reports, to examine multi-informant DRPs across two contexts. In pursuit of Aim 1, we will initially examine a non-treatment context by drawing data from a completed `Assessment Study' featuring baseline reports from parent-adolescent dyads (n=96 dyads) on the Self-Injurious Thoughts and Behaviors Interview-Revised (R15MH113076; PI/Primary Sponsor Cha). We will test whether baseline parent-adolescent DRPs about community-based adolescents' suicidal thoughts and behaviors predict their future suicidal ideation occurring 3- and 6-months later. In pursuit of Aim 2, we will then examine a treatment context by drawing data from an ongoing randomized controlled trial (i.e., `Treatment Study') featuring pre- treatment reports from parent-adolescent dyads (n=100 dyads) on the Columbia-Suicide Severity Rating Scale (R01MH123556; MPI/Co-Sponsor Yen). We will test whether pre-treatment parent-adolescent DRPs about inpatient adolescents' suicidal thoughts and behaviors predict their post-treatment suicidal ideation and behavior, and whether these effects are moderated by treatment assignment (active `Skills to Enhance Positivity' intervention vs. enhanced Treatment as Usual). Polynomial regression and response surface analyses will be used to probe the directionality and degree of parent-adolescent DRPs (Aims 1-2). With the intention of testing whether multi-informant DRPs predict adolescents' future risk across treatment and non- treatment settings, the long-term goal of this work is to maximize the prognostic value of information that is readily collected as a part of standard mental health evaluations for youth.