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，大多数有自杀高风险的青少年都未被发现和治疗，并且对于一半的青少年自杀，第一次自杀企图是致命的。为了提高对有自杀风险的青少年的识别，为了响应RFA-MH-14-070，急诊科的儿科自杀预防，我们提出了一个与儿科急诊应用研究网络（PECARN）和Whiteriver PHS印度医院的多点合作项目。这些急诊科服务于地理上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岁的青少年进行普遍的自杀风险评估，他们在随机选择的筛查班次中到14个急诊科（ed）就诊。我们将在3个月和6个月时对这些青少年中30%的子样本进行随访，这些青少年中有自杀风险因素。我们的具体目标是：(1)开发一种计算机自适应屏幕（CAS）来预测自杀企图；(2)将CAS的心理测量特性（如敏感性、特异性）与标准筛选——自杀筛选问题（ASQ）的心理测量特性进行比较；(3)测试内隐自杀认知行为测试内隐联想测验（IAT）的能力，以增加对自杀行为的预测

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.