Experiences and Outcomes of Suicidal Individuals with and without Autism in Emergency Departments Nationwide

项目总结/摘要 在美国，每年有超过50万人因自杀意念而到急诊室就诊。 (SI)和/或自杀行为（SB）。离开艾德后，他们短期内反复自残和死亡的风险 自杀率异常高。患有自闭症谱系障碍（ASD）的个体在诊断上 在艾德因自杀相关的紧急情况而就诊的人中有代表性。ASD患者最多可达9 与一般人群相比，他们经历SI的可能性高出一倍，自杀未遂的可能性高出五倍。 尽管他们的自杀风险增加，自杀相关的艾德就诊率很高，但人们对他们的自杀行为知之甚少。 ASD自杀者寻求紧急护理的经历或结果。提出的混合 方法研究将有助于长期努力，减少自杀死亡的通知适应和 为ASD患者实施基于证据的自杀预防实践。研究 目的是：（a）采用回顾性纵向设计，比较以下方面的经验和结果： 在全国范围内寻求ED中SI或SB护理的患有和不患有ASD的个体;以及（B）采访关键的 利益相关者了解如何改善基于ED的自杀预防实践，并增加ED后的心理 为ASD患者提供健康治疗。超过1亿的索赔记录公开-以及 私人保险的个人将被用来确定和跟踪一个不同的国家队列的患者， 自杀相关艾德就诊。医院和县一级的信息将来自美国医院 协会年度调查数据库，SAMHSA全国心理健康治疗机构调查，以及 区域资源文件。结果变量包括艾德出院处置、门诊心理卫生服务 使用、SI或SB复发和自杀死亡（来自国家死亡指数）。半结构 与ASD和自杀相关艾德就诊者、其家庭成员和艾德医生的访谈 将详细阐述定量研究结果，并为未来基于ED的干预提供潜在目标， 执行战略。研究结果将帮助美国各地的政策制定者和医疗保健工作者更好地 了解预防和干预ASD自杀个体的关键点。这个项目很好- 与机构间自闭症协调委员会的目标一致，以减少残疾共同发生 ASD患者的心理健康状况和过早死亡率，以及NIMH的战略目标4 加强NIMH资助研究的公共卫生影响。

PROJECT SUMMARY/ABSTRACT Over half a million people in the U.S. present annually to Emergency Departments (EDs) for suicidal ideation (SI) and/or suicidal behavior (SB). After leaving the ED, their short-term risk of repeated self-harm and death by suicide are exceptionally high. Individuals with autism spectrum disorder (ASD) are disproportionally represented among those seen in the ED for suicide-related emergencies. Individuals with ASD are up to nine times more likely to experience SI and up to five times more likely to attempt suicide than the general population. Despite their increased risk for suicide and high rates of suicide-related ED visits, little is known about the experiences or outcomes of suicidal individuals with ASD seeking emergency care. The proposed mixed methods study will contribute to long-term efforts to reduce deaths by suicide by informing the adaptation and implementation of evidence-based practices for suicide prevention for individuals with ASD. The study objectives are: (a) to use a retrospective, longitudinal design to compare the experiences and outcomes of individuals with and without ASD who sought care for SI or SB in EDs nationwide; and (b) to interview key stakeholders about ways to improve ED-based suicide prevention practices and increase post-ED mental health treatment engagement for individuals with ASD. Claims records from over 100 million publicly- and privately-insured individuals will be used to ascertain and follow a diverse national cohort of patients with a suicide-related ED visit. Hospital- and county-level information will be drawn from the American Hospital Association Annual Survey Database, SAMHSA National Survey of Mental Health Treatment Facilities, and Area Resource File. Outcome variables include ED discharge disposition, outpatient mental health service utilization, SI or SB recurrence, and death by suicide (from the National Death Index). Semi-structured interviews with individuals with ASD and suicide-related ED visits, their family members, and ED physicians will elaborate upon the quantitative findings and inform potential targets for future ED-based intervention and implementation strategies. Results will help policy makers and healthcare workers across the U.S. to better understand critical points of prevention and intervention for suicidal individuals with ASD. This project is well- aligned with the Interagency Autism Coordinating Committee's objective to reduce disabling co-occurring mental health conditions and premature mortality in people with ASD, and NIMH's Strategic Objective 4 focused on strengthening the public health impact of NIMH-funded research.