Peer mentorship to reduce suicide risk following psychiatric hospitalization

描述（由申请人提供）：自杀是死亡的主要原因，自杀未遂是残疾、生产力损失和医疗保健费用的主要原因。预防自杀是美国国立卫生研究院的研究重点，美国卫生部长的国家预防自杀战略呼吁转向以恢复为导向的预防工作，促进希望和社会支持。绝望和社会孤立是自杀的两个近端风险因素，可以通过同伴指导来改善，这是一种有效预防抑郁症和重复精神病住院的同伴支持形式。本研究的主要目的是开发和试点测试的同伴指导干预精神科住院患者在高自杀风险。干预措施将通过以下方式进行调整： 一个专家小组，从现有的同伴支持培训协议，以针对自杀风险因素， 加强自杀风险管理。还将制定培训和监督同伴导师的协议以及干预忠诚度的措施。然后，将在60名参与者中进行试点测试，这些参与者被随机分配接受同伴指导干预加常规护理或仅接受常规护理。参与者将从密歇根大学卫生系统的住院精神病学单位招募。入选标准将包括入院时自杀意念或自杀企图的医疗记录文件，排除标准将包括严重的认知障碍（根据Mini-Cog），目前接受的同伴支持，或确定同伴指导可能会对患者或同伴指导者造成困扰。同伴指导干预将包括对住院单位的亲自访问和出院后3个月的定期亲自或电话随访。干预将由同行专家提供-从严重精神疾病中稳定恢复的个人，他们接受过密歇根州的同行支持的正式培训和认证- 至少6个月的专业同行支持经验。试点研究的主要结果是干预的可接受性和可行性，如通过以下确定的：1）>50%的合格参与者登记参加研究，2）>70%的登记者在6个月时完成最终随访测量，以及3）在被分配到同伴指导干预的那些人中，>80%完成住院治疗，并且总治疗次数的中位数至少为4。同伴指导会议将被记录和评级的忠诚度。自杀意念和自杀企图的测量（后续疗效研究的预期主要结局）和次要结局（如生活质量、功能、抑郁和服务使用）将在基线、入组后3个月和6个月由对研究组不知情的研究助理获得。探索性目的将是测量干预有效性的潜在介质，和绝望的心理状态如果可接受性和可行性得到证明，该研究将产生一种新的以恢复为导向的自杀预防干预措施，为完全有效的随机对照疗效试验做好准备。

DESCRIPTION (provided by applicant): Suicide is a leading cause of death and suicide attempts are a major cause of disability, lost productivity, and health care costs. Suicide prevention is a research priority of the National Institutes of Health, and the US Surgeon General's National Strategy for Suicide Prevention calls for a shift towards recovery-oriented prevention efforts which promote hope and social support. Hopelessness and social isolation are two proximal risk factors for suicide which may be improved via peer mentorship, a form of peer support effective for preventing depression and repeat psychiatric hospitalizations. The primary aims of this study are to develop and pilot test a peer mentorship intervention for psychiatrically hospitalized patients at high risk for suicide. The intervention will be adapted by an expert panel from existing peer support training protocols to target suicide risk factors and to enhance suicide risk management. Protocols for training and supervising peer mentors and measures of intervention fidelity will also be developed. The intervention will then be pilot teste among 60 participants randomly assigned to receive the peer mentorship intervention plus usual care or usual care alone. Participants will be recruited from the inpatient psychiatry unit at the University of Michigan Health System. Inclusion criteria will include medical record documentation of suicidal ideation or suicide attempt at admission, and exclusion criteria will include significant cognitive impairment (according to the Mini-Cog), current receipt of peer support, or determination that peer mentorship may cause distress to the patient or the peer mentor. The peer mentorship intervention will include an in-person visit on the inpatient unit and regular in-person or telephone follow-up for 3 months post-discharge. The intervention will be delivered by peer specialists--individuals in stable recovery from serious mental illness who have received formal training and certification in peer support from the state of Michigan--with at least 6 months of professional peer support experience. The primary outcomes of the pilot study are acceptability and feasibility of the intervention as determined by: 1) >50% of eligible participants enroll in the study, 2) >70% of enrollees complete final follow- up measures at 6 months, and 3) among those assigned to the peer mentorship intervention, >80% complete an inpatient session and the median number of total sessions is at least 4. Peer mentorship sessions will be recorded and rated for fidelity. Measures of suicidal ideation and suicide attempts (the intended primary outcomes of a subsequent efficacy study) and secondary outcomes such as quality of life, functioning, depression, and service use will be obtained at baseline, 3 months, and 6 months post-enrollment by a research assistant blinded to study arm. An exploratory aim will be to measure potential mediators of intervention effectiveness including belongingness, burdensomeness, and hopelessness according to the interpersonal theory of suicide. If acceptability and feasibility are demonstrated, the study will result in a novel recovey-oriented suicide prevention intervention ready for a fully-powered randomized controlled efficacy trial.