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

描述(申请人提供)：自杀是美国12至17岁青少年的第二大死因。然而，大多数自杀高危青少年得不到承认和治疗，对于一半的青少年自杀，首次自杀企图是致命的。为了改进对自杀高危青少年的识别，我们建议与儿科急诊护理应用研究网络(PECARN)和Whiteriver PHS印度医院合作开展一个多地点合作项目。这些急救中心服务于地理和社会人口统计上不同的青年群体，包括自杀风险特别高的美国印第安人青年。在研究1中，我们将使用广泛的危险因素对6743名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向14个急诊科(ED)之一提出。我们将在3个月和6个月时对这些年轻人中30%的亚样本进行跟踪调查，这些样本中含有自杀风险因素。我们的具体目标是：(1)开发用于预测自杀企图的计算机化自适应筛查(CAS)；(2)比较CAS的心理测量学特性(例如，敏感度、特异度)与标准筛查的那些特性，即询问自杀筛查问题(ASQ)；(3)测试内隐联想测试(IAT)的能力，内隐联想测试(IAT)是内隐自杀认知的行为测试，以逐步增加对自杀企图的预测 超过筛查分数的自杀企图；以及(4)开发和验证基于CAS的简明算法进行风险分层，以便于对青少年进行分类。在研究2中，我们将招募2340名青少年(按自杀危险因素分层)，进行CAS和ASQ测试，并在3个月时通过访谈和病历回顾对青少年进行随访。我们的研究2的目的是验证CAS和ASQ在预测自杀企图方面的特异性和敏感性。在这一合作项目中开发的最佳筛查将有可能在全国范围内传播，以加强急救部门识别和有效分流有自杀企图的严重风险的青年的能力。该项目具有重要意义，因为在医疗保健环境中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。它极具创新性，因为它将开发和测试计算机化自适应筛查(CAS)，从而根据先前的回答产生个性化的筛查问题序列；它还将测试一系列可能纳入CAS的急性自杀风险指标。此外，该项目将测试IAT的增量价值，这一点很重要，因为许多高危青年可能会否认自杀想法。考虑到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ED环境下的青少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.