Youth Support Team Intervention for Suicidal Adolescents

正如卫生局局长在《防止自杀行动呼吁》(1999年)中强调的那样，迫切需要有效的自杀预防战略。尽管对青少年自杀风险因素有相当多的了解，但关于有效干预的研究很少。很少有随机对照干预试验对有自杀倾向的青少年进行，这些青少年的治疗依从性通常很差。这项随机对照试验将调查青年提名支持小组干预(YST)的有效性，这是一种心理教育和社交网络干预，针对自杀青少年中常见的两个问题，即治疗依从性差以及对家庭和社会支持的负面看法。它针对自杀行为高危时期的这些问题，也就是精神病住院后的12个月。自杀青少年(n=532)将从密歇根大学的儿童和青少年精神病院和大型私立精神病院Havenwyck医院招募。青少年将被随机分配到照常治疗(TAU)或照常治疗加YST(TAU+YST)组。被分配到TAU+YST的青少年将从家庭、学校和社区环境中提名三到四名成年人作为支持人员。指定的辅助者参加心理教育课程，重点是青少年的精神障碍(S)、个体化治疗计划、坚持治疗的重要性和自杀风险因素。在为期3个月的YST干预期间，支持人员与青少年保持定期联系，以支持治疗的坚持和朝着治疗目标的进展。YST干预专家与每个支持人员保持定期电话联系，以提供信息并解决关切问题。将联系青少年进行为期6周、3个月、6个月和12个月的评估。YST的疗效将通过以下方面的减少来衡量：(A)自杀意念的严重程度和频率，(B)抑郁和焦虑的严重程度，(C)自杀企图，(D)内化行为问题，以及(E)感知的社会支持，(F)治疗依从性和(G)适应功能的改善。重复测量分析将检验总体干预效果、假设的性别调节效果以及干预效果保持的程度。这项研究的结果有望提供关于YST对自杀青少年的有效性的信息，解决我们在了解提高这些青少年的治疗依从性和降低自杀风险方面的关键差距。

As highlighted in the Surgeon General's Call to Action to Prevent Suicide (1999), effective suicide prevention strategies are sorely needed. Despite substantial knowledge about adolescent suicide risk factors, there is a paucity of research on effective interventions. Few randomized controlled intervention trials have been conducted with suicidal adolescents, and treatment adherence among these adolescents is generally poor. This randomized controlled trial will investigate the efficacy of the Youth-Nominated Support Team Intervention (YST), a psychoeducational, social network intervention that targets two problems common among suicidal adolescents, poor treatment adherence and negative perceptions of family and social support. It targets these problems during a period of high risk for suicidal behavior, the 12-month period following psychiatric hospitalization. Suicidal adolescents (n = 532) will be recruited from the Child and Adolescent Psychiatric Hospital at the University of Michigan and Havenwyck Hospital, a large private psychiatric hospital. Adolescents will be randomly assigned to either treatment-as-usual (TAU) or treatment-as-usual plus YST (TAU+YST). Adolescents assigned to TAU+YST will nominate three or four adults from family, school, and community settings to function as support persons. Nominated support persons participate in a psychoeducation session that focuses on the adolescent's psychiatric disorder(s), individualized treatment plan, importance of treatment adherence, and suicide risk factors. During the 3-month YST intervention, support persons maintain regular contact with the adolescent to support treatment adherence and progress toward treatment goals. The YST intervention specialist maintains regular telephone contact with each support person to provide information and address concerns. Adolescents will be contacted for 6-week, 3-month, 6-month, and 12-month assessments. The efficacy of YST will be measured by reductions in (a) severity and frequency of suicidal ideation, (b) severity of depression and anxiety, (c) suicide attempts, (d) internalizing behavior problems, and by improvements in (e) perceived social support, (f) treatment adherence, and (g) adaptive functioning. Repeated measures analyses will test overall intervention effects, the hypothesized moderating effect of gender, and the extent to which intervention effects are maintained. Results of this study are expected to provide information about the effectiveness of YST for suicidal adolescents, addressing a critical gap in our understanding of strategies for improving treatment adherence and reducing suicide risk among these adolescents.