Adolescent Emergency Patients: Suicide Risk Detection and Treatment Facilitation

描述（由申请人提供）：自杀是美国青少年死亡的第三大原因；然而，50%以上死于自杀的青少年从未获得过任何心理健康服务。根据《国家预防自杀战略》（2001年）的建议，R34探索性研究项目将制定一项干预措施，有可能向每年寻求紧急服务的数千名处于危险中的青少年提供服务。我们将开发和试点测试一种理论驱动的干预措施，青少年改变的选择（TOC），其目的是提高问题的认识，改变的准备和治疗联系的弱势城市青少年自杀风险由于(1)抑郁症和酒精滥用共同发生，或(2)最近的自杀行为（自杀企图或严重的自杀意念）。TOC结合了动机性访谈原则，并以健康行为促进模型为基础。干预措施包括针对青少年的具有个性化反馈的适应性动机访谈（AMI），针对父母和青少年的可用治疗方法的简短联合AMI，针对文化定制的服务信息和决策援助的使用，以及个性化随访记录。具体目标是：(1)开发TOC材料（干预手册；符合文化的服务信息和决策援助；治疗师培训和忠诚评估程序）；(2)开展可行性试点研究，完善随机对照试验的干预措施和程序；(3)开展一项随机对照试验，比较TOC与常规强化治疗。该试验将使我们(a)能够估计条件下主要和次要结局的分布和变异性；(b)确定TOC的社会接受度和有效性。在这项试验中，将筛选1120名青少年，从中找出109名符合自杀风险标准并同意（征得父母同意）参加的青少年。在2个月时评估的主要结局是寻求治疗（按两种方法和参与程度定义）。二级分析将解决(1)干预对寻求治疗的影响，调整其他可能的预测因素，如年龄、性别和指标状况的严重程度；(2)寻求治疗对青少年结局的影响程度。该项目利用了我们跨学科团队在以下方面的丰富经验：对有自杀倾向的青少年的干预、对酒精滥用的紧急干预、动机性访谈，以及为健康行为制定适合不同文化的决策指南。该小组在青少年自杀风险管理方面的丰富经验加强了该项目的可行性。

DESCRIPTION (provided by applicant): Suicide is the 3rd leading cause of death among adolescents in the United States; however, more than fifty percent of adolescents who die from suicide have never obtained any mental health services. In keeping with recommendations in the National Strategy for Suicide Prevention (2001), this R34 Exploratory Research Project will develop an intervention that has the potential to be delivered to thousands of at risk adolescents seeking emergency services each year. We will develop and pilot test a theoretically-driven intervention, Teen Options for Change (TOC), which is designed to improve problem recognition, readiness for change, and treatment linkage among disadvantaged urban adolescents at risk for suicide due to either (1) co-occurring depression and alcohol misuse, or (2) recent suicidality (suicide attempt or severe suicidal ideation). TOC incorporates motivational interviewing principles and is based on health behavior promotion models. Intervention components include an Adapted Motivational Interview (AMI) with Personalized Feedback for the adolescent, a brief conjoint AMI focusing on available treatments for the parent and adolescent, use of a culturally tailored Services Information and Decision Aid, and Personalized Follow-Up Notes. Specific aims are: (1) to develop TOC materials (intervention manual; culturally tailored Services Information and Decision Aid; therapist training and fidelity assessment procedures); (2) to conduct a feasibility pilot study to refine the intervention and procedures for the randomized controlled trial; and (3) to conduct a pilot randomized controlled trial comparing TOC to enhanced treatment-as-usual. This trial will enable us (a) to estimate the distribution and variability of primary and secondary outcomes within conditions; and (b) to determine the social acceptance and validity of TOC. In this trial, 1120 adolescents will be screened to identify 109 who meet suicide risk criteria and assent (with parental consent) to participate. The primary outcome, assessed at 2-months, is treatment seeking (defined dichotomously and by level of engagement). Secondary analyses will address (1) the intervention effect on treatment seeking, adjusting for other possible predictors such as age, gender, and severity of index condition; and (2) the extent to which treatment-seeking impacts adolescent outcomes. This project capitalizes upon our interdisciplinary team's substantial experience with interventions for suicidal adolescents, emergency-based interventions for alcohol misuse, motivational interviewing, and the development of culturally tailored decision guides for health behaviors. The project's feasibility is strengthened by the team's extensive experience with adolescent suicide risk management.