Incredible Years - Parent Training

项目摘要/摘要 自杀是美国5-11岁儿童的第八大死因。2012-2017年，青年 自杀率每年以惊人的14.7%的速度增长。在此期间，急诊室就诊人数在5至18人中增加了92% -112万人。在这些访问中，近一半涉及5至11岁的儿童。然而，到目前为止， 关于儿童自杀和自杀行为(SB)的研究有限，而且没有经验支持 预防方案，尽管NIMH承认预防青少年自杀应该是国家优先事项。 一个特别脆弱的群体是父母有自杀未遂(PH+)病史的儿童。PH+儿童 与同龄人接触某人的可能性是同龄人的4-6倍，尤其是发病年龄较早--通常在10岁之前。 在本提案中，我们针对特定的父母和儿童级别的脆弱性/风险因素，其中包括 家人。尽管自杀风险是可遗传的，但现有研究表明：(1)共同的家庭环境对 SB和自杀，超过和高于遗传的影响；以及(2)特定的家庭环境机制 对某人做出贡献，然后自杀。这样的机制也包括严厉、无效和低热情的育儿方式 因为亲子沟通受到损害，父母对孩子的行为监测不力。这些育儿方式 练习加强情绪不稳定和情绪失调，这对父母和 高危家庭中的儿童。在我们之前的研究(R21MH116206)中，6-9岁的PH+儿童报告的较少 家庭凝聚力和PH+父母报告的父母更宽容的父母，这与严厉共存， 敌意和情绪失调。针对这些育儿做法并改进的有效干预措施 亲子情绪调节(ER)可能会降低青少年SB的风险，但尚未在PH+中进行测试 家人。我们将比较虚拟版的Uncredible Year®家长培训(IY-PT)和增强型日常护理 (EUC)。IY-PT降低了父母的情绪反应性，并教会他们有效地对孩子进行 成功的急诊室。IY-PT有效地增加了父母的积极养育，提高了父母和父母的ER技能 儿童，效果规模大，保持1年和2年的随访。我们将(1)测试可接受性和 从父母和临床医生的角度对这一人群进行虚拟IY-PT的可行性；(2)确定 IY-PT在降低PH+青少年自杀风险方面是有效的；和(3)探讨可接受性和可行性，如 PH+状态与父母和孩子结局之间的潜在调节因素。急诊室和育儿是主要的 结果以及NSSI、SI和抑郁症状是次要结果。措施包括采访， 直接观察和自我报告。参与者包括100个PH+家庭，他们将完成基线，BE 随机到虚拟IY-PT或EUC，并在干预后完成1个月、3个月和6个月的重新评估。这 有效性-实施混合模型设计I，以PRISM实施科学框架为指导， 可能会对预防高危青年中迫在眉睫的公共卫生问题产生重大影响。

Project Summary/Abstract Suicide is the eighth leading cause of death among U.S. children ages 5-11 years. From 2012-2017, youth suicides increased at an alarming 14.7% annually. During this time, ER visits increased 92% among 5- to 18- year-olds—to 1.12 million. Almost half of these visits involved a 5- to 11-year-old child. To date, however, limited research on child suicide and suicidal behavior (SB) exists, and there are no empirically supported prevention programs despite recognition by NIMH that youth suicide prevention should be a national priority. One especially vulnerable group is children with a parental history of suicide attempts (PH+). PH+ children are 4-6x more likely to engage in SB than their peers and show especially early age of onset—often before age 10. In this proposal, we target specific parent- and child-level vulnerabilities/risk factors for SB among these families. Although suicide risk is heritable, existing research shows (1) effects of shared family environment on SB and suicide, over-and-above genetic influences; and (2) specific family environment mechanisms that contribute to SB and suicide. Such mechanisms include harsh, invalidating, and low-warmth parenting, as well as impaired parent-child communication and poor parental monitoring of children’s behavior. These parenting practices reinforce emotional lability and emotion dysregulation, which are common to both parents and children in at-risk families. In our previous study (R21MH116206), PH+ children, ages 6-9 years, reported less family cohesion, and PH+ parents reported more permissive parenting, which co-occurs with harshness, hostility, and emotion dysregulation. Effective interventions that target these parenting practices and improve parent and child emotion regulation (ER) may reduce risk for youth SB but have not been tested in PH+ families. We will compare a virtual version of Incredible Years® parent training (IY-PT) to Enhanced Usual Care (EUC). IY-PT decreases parents’ emotional reactivity and teaches them to effectively “coach” their children on successful ER. IY-PT is effective in increasing positive parenting and improving ER skills of both parents and children, with large effect sizes that maintain at 1- and 2-year follow-ups. We will (1) test acceptability and feasibility of virtual IY-PT for this population from both parent and clinician perspectives; (2) determine whether IY-PT is effective in decreasing suicide risk among PH+ youth; and (3) explore acceptability and feasibility as potential moderators between PH+ status and parent and child outcome. ER and parenting are primary outcomes and NSSI, SI, and depressive symptoms are secondary outcomes. Measures include interviews, direct observations, and self-reports. Participants include 100 PH+ families who will complete a baseline, be randomized to virtual IY-PT or EUC, and complete 1-,3-, and 6-month reassessments post-intervention. This effectiveness-implementation hybrid model design I, guided by PRISM Implementation Science Framework, could have major implications for preventing an imminent public health concern among at-risk youth.