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

 描述（由申请人提供）：高自杀率是美国印第安人和阿拉斯加原住民（AI/AN）年轻人的地方病。最近的一项研究发现，北方平原和阿拉斯加的年轻AI/AN成年人的发病率比同一地区同龄白人的发病率高出4倍以上。建立社会联系是预防自杀的一个关键目标。一个经过验证的理论模型认为，属于一个群体是人类的基本需求。当这种需要被社会孤立或社会支持不足所阻碍时，死亡的欲望就会出现。人工智能/人工神经网络的自杀预防研究强调了与朋友，家人，爱心邻居和社区领袖联系的文化重要性。这些社区凝聚力的传统可以用来保护年轻的AI/AN成年人免受自杀意念和行为的影响。关怀联系人是一个自杀预防计划，通过促进人与人之间的联系来补充标准护理。有自杀风险的人往往与医疗保健系统失去联系，得不到后续护理。在最初介绍后的一年内，Caring Contacts寻找这样的人发送信息，表达关心，关注和兴趣。这是唯一一项在随机对照试验中显示可以预防任何人群自杀的干预措施。基于与四个部落合作伙伴近两年的合作过程，作为试点赠款的一部分，我们设计了一个当地可行的，文化上适当的关怀联系人干预措施，将使用短信，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）来评估来自我们四个合作社区的1，200名18-34岁的高风险AI/AN的自杀预防方法。我们的具体目标是：1）比较常规护理（对照）与对照条件加护理短信（干预）对减少自杀意念、自杀企图和自杀相关住院的有效性。2)评估社会联系作为通过短信进行关怀联系对自杀倾向影响的中介因素。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通过调整和传播在非本地人口中证明有效的关怀接触方法，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/AN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.