Concurrent Treatment for Parents and Adolescents Who Attempt Suicide

说明(由申请人提供)：每年约有200万青少年企图自杀，70万青少年接受紧急医疗(Shaffer&Pfeffer，2001)。青少年自杀未遂者的治疗因父母的精神病理学而变得复杂，已发现与正常对照组相比，这一组的自杀未遂者显著升高。所有父母的精神病态都可能通过几种途径与他们青少年的自杀倾向有关。首先，自杀行为和/或更普遍的精神病理(如情感障碍)的遗传传递可能是父母功能影响青少年自杀行为的机制。事实上，一些研究发现，在试图自杀的青少年中，父母自杀行为的比率很高。其次，过去或现在有自杀史的父母可能会为他们的青少年树立自杀行为的榜样。第三，这些家庭的家庭过程可能对自杀特别敏感。例如，这些家庭可能无意中通过注意力强化了自杀行为，或者青少年可能利用自杀行为来终止令人厌恶的家庭关系模式。第四，父母的精神障碍可能会导致厌恶父母的方式，从而可能导致青少年的自杀想法或行为(Downey&Coyne，1990)。最后，父母的功能可能会影响父母完成青少年治疗的能力，这反过来又会影响治疗取得的进展。此应用程序的目的是开发一种治疗方案，如果父母被诊断为严重抑郁障碍，则同时治疗企图自杀的青少年及其父母，通常是母亲。提出了治疗发展的两步序列。第一阶段包括治疗师培训、飞行员测试、方案修订以及一项小型公开试验。同时的治疗方案将包括针对青少年和父母的单独治疗，但也包括育儿和家庭治疗。在第二阶段，我们将进行一项小型随机试验，并将试验性同步治疗方案与青少年单独治疗进行比较。在精神病住院病房住院的青少年或在自杀未遂后在急诊科接受治疗的青少年将被招募参加这项研究。将在治疗结束时和治疗后6个月评估结果。通过将这些青少年的治疗与他们父母的治疗相结合，并对两者使用相同的治疗原则，我们假设，与通常单独治疗青少年时相比，实验方案将导致自杀意念和治疗成功(即不重复自杀企图，不重复住院)方面的更大改善。青少年自杀是青春期死亡的第三大原因。这个应用程序测试了一种针对自杀青少年和抑郁父母的综合方案。减少14至17岁青少年的伤害性自杀企图和15至19岁青少年完全自杀的发生率是本申请书涉及的2010年目标。

DESCRIPTION (provided by applicant): Approximately 2 million adolescents attempt suicide each year and 700,000 receive emergency medical treatment each year (Shaffer & Pfeffer, 2001). Treatment of adolescent suicide attempters is complicated by parental psychopathology, which has been found to be significantly elevated in this group compared to normal controls. There are several pathways by which all parents' psychopathology may be related to their adolescent's suicidality. First, genetic transmission of either suicidal behavior and/or more general psychopathology, such as an affective disorder, may be the mechanism by which parent functioning affects adolescent suicidal behavior. Indeed, a number of studies have found high rates of parental suicidal behavior among adolescents who attempt suicide. Second, parents with a history of past or current suicidality may model suicidal behavior for their adolescent. Third, family processes in these families may be especially sensitive to suicidality. For example, these families may inadvertently reinforce suicidal behavior via attention, or adolescents may use suicidal behavior to terminate aversive family relationship patterns. Fourth, parental psychiatric disorders may lead to aversive parenting in such a way that it may lead to an adolescent's suicidal thinking or behavior (Downey & Coyne, 1990). Finally, parental functioning may affect a parent's ability to follow through with their adolescent's treatment attendance, which in turn can affect progress made in therapy. The purpose of this application is to develop a treatment protocol that simultaneously treats the adolescent who attempts suicide and his/her parent, most typically a mother, if the parent is diagnosed with major depressive disorder. A two-step sequence of treatment development is proposed. Phase I includes therapist training, pilot testing, and protocol revisions as well as a small open trial. The concurrent treatment protocol will include both individual sessions for adolescents and parents but also parenting and family sessions. In Phase II we will conduct a small randomized trial and compare the experimental concurrent treatment protocol to treatment of the adolescent alone. Adolescents hospitalized on a psychiatric inpatient unit or treated in the Emergency Department following a suicide attempt will be recruited to participate in the study. Outcome will be assessed at the end of treatment and 6 months post-treatment. By integrating the treatment of these adolescents with that of their parents and using the same treatment principles for both, we hypothesize that the experimental protocol will lead to greater improvements in suicidal ideation and treatment success (i.e., no repeat suicide attempts, no repeat hospitalizations) than that typically found when an adolescent is treated individually. Adolescent suicide is the third leading cause of death during adolescence. This application tests an integrated protocol for suicidal adolescents and a depressed parent. Reducing the incidence of injurious suicide attempts among adolescents 14 to 17 years old and completed suicide among youth 15 to 19 years old are Year 2010 objectives addressed in this application.