Quality of Care for Adolescent Suicide Attempters

描述（由申请人提供）：本提案的培训和研究目标旨在为申请人提供必要的技能，使其成为一名独立的精神卫生服务调查员，能够研究自杀未遂后青少年接受护理的过程和结果。每年在美国，近70万青少年在企图自杀后得到医疗照顾。改善自杀未遂后的结果具有重要的经济和公共卫生意义。尽管问题规模很大，但我们对如何为自杀青年提供有效护理的知识仍然有限。 职业发展和研究计划将建立在申请人在精神病学和生物统计学方面的强大培训基础上，并为他提供（1）卫生服务和护理研究质量，（2）临床评估和决策，以及（3）定性研究方法的额外技能。这些目标与NIMH关于连接科学与服务的建议是一致的。 本申请的研究目的是对自杀未遂的青少年所接受的护理质量进行混合方法研究。第一个项目将是对青少年自杀者及其父母进行定性评估，以深入了解对护理理想特征的看法，家庭和护理服务障碍，以及促进或阻碍遵守治疗建议的问题。第二个项目将是一个自然的，纵向跟踪调查的连续样本的180名青少年谁目前西方精神病研究所和诊所的急诊室（ER）自杀未遂后。受试者将在首次ER入院后3个月再次接受访视。该项目的主要目标是描述自杀未遂后接受或未接受指南推荐护理的青少年的特征，并确定与接受GRC相关的人口统计学，心理社会学和临床患者特征。作为一个探索性的目标，我们将探讨未能接受指南推荐的护理是否会增加重复自杀企图的风险，控制已知的再企图风险因素。这些项目将共同为未来R01提案的设计提供信息，该提案旨在研究更广泛的服务提供者和治疗环境中的高风险青少年的护理因素和结果的质量。

DESCRIPTION (provided by applicant): The training and research aims of this proposal are intended to provide the applicant with the skills necessary to become an independent mental health services investigator capable of studying the processes and outcomes of care received by adolescents following a suicide attempt. Each year in the U.S., nearly 700,000 adolescents receive medical attention following a suicide attempt. Improvement of outcome after a suicide attempt has important economic and public health implications. Despite the scale of the problem, our knowledge of how to provide effective care to suicidal youth remains limited. The career development and research programs will build on the applicant's strong training in psychiatric epidemiology and biostatistics and provide him with additional skills in (1) health services and quality of care research, (2) clinical assessment and decision-making, and (3) qualitative research methods. These goals are consistent with NIMH's recommendations of bridging science and service. The research aim of this application is to conduct a mixed-methods study of the quality of care received by adolescents following a suicide attempt. The first project will be a qualitative evaluation of adolescent suicide attempters and their parents to develop an in-depth understanding of perceptions of ideal characteristics of care, family and service barriers to care, and issues that promote or impede adherence to treatment recommendations. The second project will be a naturalistic, longitudinal follow-up investigation of a consecutive sample of 180 adolescents who present to the Western Psychiatric Institute and Clinic's emergency room (ER) following a suicide attempt. Subjects will be re-interviewed 3 months following their initial ER admission. The primary goals of this project will be to characterize youth who receive or fail to receive elements of guideline recommended care following a suicide attempt, and identify demographic, psychosocial, and clinical patient characteristics associated with receiving GRC. As an exploratory aim, we will probe whether failing to receive guideline recommended care increases the risk of repeated suicide attempt, controlling for known risk factors of reattempt. Together, these projects will inform the design of a future R01 proposal aimed at studying quality of care factors and outcome for at-risk youth across a broader range of service providers and treatment settings.