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，使其成为能够研究青少年自杀未遂后接受护理的过程和结果的独立精神健康服务调查员。在美国，每年有近70万青少年在自杀未遂后接受医疗护理。自杀未遂后结果的改善具有重要的经济和公共卫生影响。尽管问题的规模很大，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者在精神流行病学和生物统计学方面的强大培训的基础上，并为他提供(1)保健服务和护理质量研究、(2)临床评估和决策以及(3)定性研究方法方面的额外技能。这些目标与NIMH关于连接科学和服务的建议是一致的。 本申请的研究目的是对青少年自杀未遂后接受的护理质量进行一项混合方法研究。第一个项目将对青少年自杀未遂者及其父母进行定性评估，以深入了解人们对护理的理想特征、家庭和服务障碍以及促进或阻碍遵守治疗建议的问题的看法。第二个项目将是一项自然的、纵向的跟踪调查，对180名青少年进行连续抽样，这些青少年在自杀未遂后出现在西方精神病学研究所和诊所的急诊室(ER)。受试者将在首次进入急诊室3个月后重新面谈。该项目的主要目标将是确定在自杀未遂后接受或未能接受指南建议护理的年轻人的特征，并确定与接受GRC相关的人口统计学、心理社会和临床患者特征。作为一项探索性目标，我们将调查未能接受指南推荐的护理是否会增加重复自杀未遂的风险，并控制已知的再次自杀未遂的危险因素。这些项目将共同为未来R01提案的设计提供参考，旨在研究更广泛的服务提供者和治疗环境中高危青年的护理质量因素和结果。

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.