Development of an Intervention for Suicide Attempters

描述(申请人提供)：自杀和企图自杀是美国的主要公共卫生问题，2000年自杀导致超过29,000人死亡，企图自杀导致超过400,000人住院。尽管近年来我们在许多精神疾病的有效治疗方面的知识取得了重大进展，但这个国家的自杀率并没有大幅下降。尽管自杀对公共健康的重要性很高，而且我们目前的精神治疗显然无法影响自杀率，但致力于开发或测试直接针对自杀行为的干预措施的研究相对较少。这一治疗发展赠款试图通过为以前有过自杀未遂的个人开发一个综合的、辅助的治疗计划来解决这一限制。更具体地说，我们建议开发一种治疗方案，旨在减少高危样本中随后的自杀行为-患有严重抑郁症的成年患者在自杀未遂后住进精神病院。在其初步形式中，这一干预措施暂定为应对长期自杀未遂方案，由三个主要部分组成：a)患者在医院期间的三次单独会议，b)与患者及其重要的另一半(S)的一次面对面会议，以及c)出院后与患者和重要的另一半进行一系列预定的电话联系，以及六个月的其他重要会议。这项申请的总体目标是进一步发展CLAP干预，并收集关于这一治疗计划有效性的初步数据。更具体地说，我们建议：1.为CLAP治疗制定一份全面的治疗手册--一种多模式干预，包括认知-行为心理治疗和家庭干预的治疗策略的整合。2.制定、实施和评估治疗师培训计划。3.开发和测试依从性和能力评定量表的信度和效度，以评估治疗师对治疗手册的依从性和他们提供治疗的能力。4.在最近有自杀企图的住院患者样本中进行随机对照初步研究，以：a)评估拟议治疗的可行性和可接受性，以及b)提供与通常的强化治疗相比，CLAP在减少自杀行为方面的有效性的估计。这项先导性研究将为更大规模的临床试验奠定基础，评估这种新的自杀疗法在这一高危人群中的疗效。

DESCRIPTION (provided by applicant): Suicide and attempted suicide are major public health issues in the United States, with suicide accounting for more than 29,000 deaths in the year 2000 and attempted suicide accounting for over 400,000 hospital admissions. Although recent years have seen significant advances in our knowledge of efficacious treatments for many psychiatric disorders, the suicide rates in this country have not decreased substantially. Despite the high public health significance of suicide and the apparent inability of our current psychiatric treatments to influence suicide rates, there has been relatively little research devoted to developing or testing interventions that directly target suicidal behavior. This treatment development grant seeks to address this limitation by developing an integrated, adjunctive treatment program for individuals who have made a previous suicide attempt. More specifically, we propose to develop a treatment program aimed at reducing subsequent suicidal behavior in a high risk sample - adult patients with major depression admitted to a psychiatric hospital following a suicide attempt. In its preliminary format, this intervention, tentatively named the Coping Long- term with Attempted Suicide Program (CLASP), is comprised of three major components: a) three individual meetings while the patient is in the hospital, b) one in-person meeting with the patient and his/her significant other(s) and c) a series of scheduled telephone contacts with the patient and significant other for six months following discharge from the hospital. The overall aim of this application is to further develop the CLASP intervention and to collect preliminary data on the efficacy of this treatment program. More specifically, we propose to: 1. Develop a comprehensive treatment manual for the CLASP treatment - a multi-modal intervention that consists of an integration of treatment strategies from cognitive-behavioral psychotherapies and family interventions. 2. Develop, implement and evaluate a therapist training program. 3. Develop and test the reliability and validity of adherence and competence rating scales to evaluate therapists' adherence to the treatment manual and their competence in delivering the treatment. 4. Conduct a randomized controlled pilot study in a sample of inpatients with a recent suicide attempt to: a) assess the feasibility and acceptability of the proposed treatment, and b) to provide an estimate of effect size of the efficacy of CLASP in reducing suicidal behavior in comparison to Enhanced Treatment As Usual. This pilot study will lay the groundwork for a larger clinical trial evaluating the efficacy of this new treatment for suicide in this high risk group of patients.