Emergency Department Screen for Teens at Risk for Suicide (ED-STARS)

描述（由申请人提供）：自杀是美国12至17岁青少年死亡的第二大原因。然而，大多数自杀高危青年未被识别和治疗，对于一半的青少年自杀，第一次自杀企图是致命的。为了提高对自杀高危青年的识别，响应RFA-MH-14-070，急诊科的儿科自杀预防，我们提出了一个多站点的合作项目，与儿科急救护理应用研究网络（PECARN）和Whiteriver PHS印度医院。这些ED服务于地理和社会人口统计学上不同的青年群体，包括自杀风险特别高的美洲印第安青年。在研究1中，我们将使用广泛的风险因素对6743名年龄在12至17岁之间的青少年进行通用自杀风险评估，这些青少年在随机选择的筛选班次期间前往14个急诊科（ED）之一。我们将在3个月和6个月时对这些青年中的30%进行子样本的随访，这些青年富含自杀风险因素。我们的具体目标是：（1）开发一个计算机化的自适应屏幕（CAS）来预测自杀企图;（2）比较心理测量特性（例如，（3）测试内隐联想测验（IAT）的能力，内隐联想测验是一种内隐自杀认知的行为测试，它增加了对自杀认知的预测能力。 自杀企图高于和超越筛选分数;（4）开发和验证一个简约的基于CAS的风险分层算法，以促进青少年的分流。在研究2中，我们将招募一个新的样本2340青年（分层的自杀风险因素），administe CAS和ASQ，并在3个月的随访青年访谈和病历审查。我们的研究2的目的是验证CAS和ASQ预测自杀企图的特异性和敏感性。在这一合作项目中开发的最佳筛选将有可能在全国范围内传播，以提高急诊部门识别和有效分流自杀企图高危青年的能力。该项目意义重大，因为在医疗机构对高危青年进行筛查和分类是国家预防自杀战略的关键战略，以减少青少年自杀。它具有高度创新性，因为它将开发和测试一种计算机化的自适应筛选（CAS），这将导致以先前的回答为条件的筛选问题的个性化序列;它将测试广泛的急性自杀风险指标，以便可能纳入CAS。此外，该项目将测试IAT的增量值，这一点很重要，因为许多高危青年可能会否认自杀念头。鉴于PECARN强大的基础设施和成功招募的记录，以及调查小组在多地点研究、计算机化适应性测试和艾德环境中的青年自杀研究方面的集体经验，该项目是可行的。

DESCRIPTION (provided by applicant): Suicide is the 2nd leading cause of death among youth ages 12 to 17 in the United States. However, most youth at high risk for suicide go unrecognized and untreated, and for half of adolescent suicides, the first suicide attempt is fatal To improve identification of youth at risk for suicide, in response to RFA-MH-14-070, Pediatric Suicide Prevention in Emergency Departments, we propose a multi-site collaborative project with the Pediatric Emergency Care Applied Research Network (PECARN) and the Whiteriver PHS Indian Hospital. These EDs serve geographically and socio-demographically diverse groups of youth, including American Indian youth who are at particularly high risk for suicide. In Study 1, we will implement a universal suicide risk assessment using a broad range of risk factors with 6743 youth, ages 12 to 17 years, who present to one of 14 emergency departments (EDs) during randomly chosen screening shifts. We will follow-up a subsample of 30% of these youth, enriched for suicide risk factors, at 3 and 6 months. Our specific aims are to: (1) develop a computerized adaptive screen (CAS) for predicting suicide attempts; (2) compare the psychometric properties (e.g., sensitivity, specificity) of the CAS to those of a standard screen, the Ask Suicide-Screening Questions (ASQ); (3) test the ability of the Implicit Association Test (IAT), a behavioral test of implicit suicidal cognitions, to add incrementally to the prediction of suicide attempts above and beyond screening scores; and (4) develop and validate a parsimonious CAS-based algorithm for risk stratification to facilitate the triage of youths. In Study 2, we will recruit a new sample of 2340 youth (stratified by suicide risk factors), administe the CAS and ASQ, and follow-up youth at 3-months with interviews and medical chart reviews. Our Study 2 aim is to validate the specificity and sensitivity of the CAS and ASQ for predicting suicide attempts. The optimal screen developed in this collaborative project will have the potential to be disseminated nationwide to enhance the capacity of emergency departments to identify and effectively triage youth at acute risk for suicide attempts. This project is significat because the screening and triage of at-risk youth in healthcare settings are key strategies of the National Strategy for Suicide Prevention to reduce adolescent suicide. It is highly innovative because it will develop and test a computerized adaptive screen (CAS), which results in individualized sequences of screening questions conditional on previous responses; and it will test a wide range of acute suicide risk indicators for possible inclusion in the CAS. In addition, this project will test the incremental value of the IAT, which is important as many at-risk youth may deny suicidal thoughts. This project is feasible given PECARN's strong infrastructure and record of successful recruitment, and the investigative team's collective experience in multi-site studies, computerized adaptive testing, and youth suicide research in ED settings.