DCIPS: Intervention with High Suicide Risk Individuals

描述(申请人提供)：本申请是对RFA-MH-04-003，“发展中的预防自杀干预中心(DCIPS)”的回应。虽然美国自杀和自杀未遂的发生率很高，但针对这一群体的有效治疗方法的研究远远落后。对自杀干预进行的随机对照试验不到40项，无论是药物干预还是心理干预。因此，从临床试验的角度来看，精神病学中最致命的疾病受到的关注最少，许多常用的干预措施从未经过经验测试。 自杀的最重要的危险因素是既往自杀行为、严重和持续的自杀意念以及酒精和物质使用障碍的共病。为了开发对减少自杀企图和自杀有直接影响的干预措施，自杀人群中的这一高危部分是本中心的重点。将针对易于出口和易于培训的干预措施，如药物战略和简短的心理社会干预。 主要目标是与青少年和成年人的高自杀风险个人有关：1.促进、发展和进行功效研究，以测试和适应针对自杀行为的药理学、心理社会和综合干预措施；2.鼓励自杀个人在道德和临床上合理地纳入干预研究，他们通常被排除在针对其原发障碍的干预研究之外；3.与当地精神科急诊室建立伙伴关系和网络，为自杀个人制定更有效的转介和后续程序；以及4.制订策略，以加强自杀者在急诊室就诊和被招募入干预试验后的治疗参与度、依从性和留存力；5.为自杀干预试验加强可靠和准确的自杀评估和测量发展；以及6.制定策略，以了解和管理在进行自杀干预研究时复杂的临床和伦理问题。

DESCRIPTION (provided by applicant): This application is in response to RFA-MH-04-003, "Developing Centers on Intervention for the Prevention of Suicide (DCIPS)." While there is a high incidence of suicide and suicide attempts in the United States, research on effective treatments for this population has lagged far behind. Fewer than forty randomized controlled trials of suicide interventions, either pharmacological or psychosocial have been conducted. Thus, the most deadly condition in psychiatry has received the least attention from a clinical trials perspective and many commonly used interventions have never been tested empirically. The most significant risk factors for suicide are prior suicidal behavior, serious and persistent suicide ideation and co-morbid alcohol (AUD) and substance use disorders (SUD). In an effort to develop interventions that have a direct impact on reducing suicide attempts and suicide, this high-risk segment of the suicidal population is the focus of our Center. Interventions that are readily exportable and easily trained, such as medication strategies and brief psychosocial interventions will be targeted. The primary goals, each with a training component, are related to high suicide risk individuals, both adolescent and adult: 1. to promote, develop and conduct efficacy studies that test and adapt pharmacological, psychosocial and combined interventions targeting suicidal behaviors; 2. to stimulate ethically and clinically-sound inclusion of suicidal individuals in intervention studies, from which they are typically excluded targeting their primary disorder, e.g. depression, bipolar disorder, AUD and SUD; 3. to develop a model of partnership and network with local Psychiatric Emergency Rooms to develop a more effective referral and follow-up process for suicidal individuals; and 4. to develop strategies to enhance treatment engagement, adherence and retention of suicidal individuals both following ER visits and after recruitment into intervention trials; 5. to enhance reliable and accurate suicide assessment and measurement development for suicide intervention trials; and 6. to develop strategies for understanding and managing the complex clinical and ethical issues in conducting suicide intervention research.