Relapse Prevention for Suicidal Dually Diagnosed Youths

描述（由申请人提供）：开发和测试自杀青少年的干预措施是公共卫生的优先事项。酒精和物质使用障碍以及抑郁症都与青少年自杀行为的风险增加有关，并且通常共同发生。然而，干预措施还没有专门为自杀双重诊断的青年。本研究的目的是开发，完善和试点测试的认知行为复发预防干预（CBT-RP）的这一人群。CBT-RP基于Mariatt和Gordon（1985）的复发预防模型。CBT-RP融合了认知行为复发预防，动机增强方法和正念冥想，并将复发预防模型对酒精和物质使用的原始关注扩展到自杀结果和抑郁症。治疗开发将遵循Rounsaville等人（2001年）的建议，并将在一项初步随机对照试验（RCT）中达到高潮，以确定与CBT-RP相关的效果（n=36）。该项目的首要目标是开发和完善CBT-RP和“增强支持性护理”（试点RCT中的比较干预）的治疗手册和程序。第二个目标是开发和试点测试程序，用于培训CBT-RP治疗和加强支持性护理。第三个目标是通过监测受试者的招募和保留、监测治疗师对方案的遵守情况以及监测不良事件来评估CBT-RP和加强支持性护理的可行性。第四个目标是评估完成评估的负担所反映的评估方法的可行性。第五个目的是估计CBT-RP +氟西汀相对于加强支持治疗+氟西汀对主要结局（自杀意念、抑郁症状和药物滥用问题严重程度）的反应变化程度和变异性。研究中所有青少年均处方氟西汀，以（a）提高研究结果的普遍性（考虑到大多数抑郁、寻求治疗的青少年接受抗抑郁药物治疗），以及（B）出于对弱势群体抑郁症的有效治疗的伦理考虑。最后的目的是评估CBT-RP的可接受性，通过退出访谈和患者满意度的评级。这些结果将用于设计一项充分把握度的多中心RCT，以检查CBT-RP对自杀性双重诊断青少年的疗效。

DESCRIPTION (provided by applicant): Development and testing of interventions for suicidal adolescents are public health priorities. Alcohol and substance use disorders and depressive disorders are both associated with increased risk of suicidal behavior in adolescents and commonly co-occur. However, interventions have not been specifically developed for suicidal dually diagnosed youths. The purpose of this study is to develop, refine, and pilot test a cognitive behavioral relapse prevention intervention (CBT-RP) for this population. CBT-RP is based on the relapse prevention model of Mariatt and Gordon (1985). CBT-RP melds cognitive behavioral relapse prevention, motivational enhancement approaches, and mindfulness meditation, and extends the original focus of the relapse prevention model on alcohol and substance use to suicidal outcomes and depression. Treatment development will follow recommendations of Rounsaville et al. (2001) and will culminate in a pilot randomized controlled trial (RCT) to determine the effects associated with CBT-RP (n=36). The first aim of this project is to develop and refine treatment manuals and procedures for CBT-RP and for "enhanced supportive care" (the comparison intervention in the pilot RCT). The second aim is to develop and pilot test procedures for training CBT-RP therapy and enhanced supportive care. The third aim is to assess the feasibility of CBT-RP and enhanced supportive care via monitoring of recruitment and retention of subjects, monitoring of therapist adherence to the protocol, and monitoring of adverse events. The fourth aim is to assess the feasibility of assessment methods as reflected in the burden of completing assessments. The fifth aim is to estimate the degree of change and variability of response to CBT-RP + fluoxetine relative to enhanced supportive care + fluoxetine on the primary outcomes (suicidal ideation, depressive symptoms, and substance abuse problem severity). Fluoxetine is prescribed for all adolescents in the study (a) to improve the generalizability of findings (given that the majority of depressed, treatment -seeking youths receive antidepressant medication), and (b) because of ethical concerns about withholding an efficacious treatment for depression with a vulnerable group. The final aim is to assess the acceptability of CBT-RP via exit interviews and ratings of patient satisfaction. These results will be used to design an adequately powered, multi-site RCT examining the efficacy of CBT-RP for suicidal dually diagnosed adolescents.