Youth Suicide Prevention: Maintaining Long Term Change

描述(申请人提供)：自杀仍然是年轻人的主要死亡原因--每年有五分之一的青少年考虑自杀，大约一百万人试图自杀。这些比率持续上升到青壮年。青少年自杀危险行为是一个重大的公共卫生问题，值得立即关注促进短期和长期行为改变的关键干预因素。这项建议考察了参与指定的自杀预防计划后与长期行为变化相关的心理社会过程，并具体回应了RFA OB-03-003。该提案利用了一项即将完成的预防试验，促进了由国家护理研究所资助的护理工作。该计划已经证明了对有自杀倾向的高中生的短期效果。促进关怀研究将提供大约550名弱势青年的样本，随机分配到3种实验条件中的1种，并与“照常”干预进行比较。这项研究已得到严格执行，在基线、干预后、基线后9个月和15个月收集了广泛的测量，对于一半的样本，收集了30个月的测量。 通过长达48个月的随访，我们将1)测试长期干预效果；2)测试理论模型，检查中介干预对短期和长期行为结果的影响；3)确定随时间变化的轨迹。先进的统计程序(潜在生长模型，SEM)将被用来检查行为变化，并检验假想的中介干预效果。干预过程和生命过程因素对变化模式的影响将使用多方法方法和探索性分析策略进行研究。建议的研究具有创新性和重要意义，对理论检验和预防科学具有重要意义。这项研究应该会显著增加我们对青年和家庭为易自杀青年提供预防干预以遏制抑郁、愤怒和自杀危险行为的方式的理解。

DESCRIPTION (provided by applicant): Suicide remains a leading cause of death among young people--each year 1 in 5 teenagers considers suicide and approximately one million attempt suicide. These rates continue to escalate into young adulthood. Youth suicide-risk behavior is a major public health problem deserving immediate attention to critical intervention factors that promote short-term and maintain long-term behavioral change. This proposal examines psychosocial processes associated long-term behavioral change following participation in an indicated suicide prevention program, and responds specifically to RFA OB-03-003. The proposal takes advantage of a nearly completed prevention trial, Promoting CARE funded by the National Institute for Nursing Research. The program has demonstrated short-term outcome effects for suicide-vulnerable high school youth. The Promoting CARE study will provide a sample of approximately 550 vulnerable youth, randomly assigned to 1 of 3 experimental conditions, and compared to intervention "as usual." The study has been rigorously implemented, with extensive measures collected at baseline, post-intervention, 9 and 15 months post-baseline, and, for half the sample, at 30 months. With an extended follow-up to 48 months, we will 1) test for long-term intervention effects; 2) test the theoretic model, examining for mediational intervention effects on both short- and long-term behavioral outcomes; and 3) identify trajectories of change across time. Advanced statistical procedures (latent growth models, SEM) will be used to examine behavioral change and to test hypothesized mediating intervention effects. The influence of intervention processes and life course factors on patterns of change will be examined using multi-method approaches and exploratory analytic strategies. The proposed study is innovative and significant; it has implications for theory testing and prevention science. This research should markedly increase our understanding of ways in which youth and family-focused preventive interventions for suicide-vulnerable youth work to curb depression, anger and suicide-risk behaviors.