TREATMENT OF ADOLESCENT SUICIDE ATTEMPTERS (TASA)

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。青少年自杀是15-19岁青年死亡的第三大原因，是一个重大的公共卫生问题。尽管我们对青少年自杀行为的危险因素的理解取得了重要进展，但我们对其治疗知之甚少，因为：1)尽管有证据表明抑郁症和过去的自杀企图都是青少年自杀的强烈危险因素，但有自杀倾向的青少年通常被排除在青少年抑郁症的临床治疗试验之外；2)很少有良好的对照研究将青少年自杀行为作为主要焦点。因此，治疗青少年抑郁自杀企图者的正确方法尚不清楚。美国儿童和青少年精神病学学会（AACAP）发布了实践参数/指南，并为TASA青少年的评估和治疗设定了最低标准，但这些指南没有经验支持。拟议的研究将提供可行性数据，以进行一项大型多地点临床试验，比较药物加支持性临床护理（MM）、认知行为治疗（CBT-TASA）、联合治疗（MM+CBT-TASA）对患有抑郁症和最近有自杀企图的青少年的疗效。我们建议对120名12-18岁的抑郁青少年自杀未遂者（每个站点24人）进行三组混合随机对照/偏好试验。在该设计中，并非所有患者都将随机分配到其中一种治疗条件；相反，患者可以选择随机分配到一种可用的治疗条件，或者他们可以选择一种可用的治疗条件。那些没有治疗偏好的患者或家庭将被随机分配到三种治疗条件中的一种。以稳定剂量抗抑郁药物进入研究的受试者将仅符合随机或选择MM或MM+CBT治疗条件的资格。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. As the third leading cause of death among youth 15-19 years old, adolescent suicide is a major public health concern. Despite important advances in our understanding of the risk factors for adolescent suicidal behavior, there is little known about its treatment because: 1) although there is evidence that both depression and past suicide attempt are strong risk factors for adolescent suicide, suicidal adolescents have been routinely excluded from clinical treatment trials of adolescent depression and 2) there are few well-controlled studies conducted in which adolescent suicidal behavior was the primary focus. As such, the proper approach to treatment of depressed adolescent suicide attempters is not known. Practice parameter/guidelines have been published by the American Academy of child and Adolescent Psychiatry (AACAP) and set a minimal standard for the assessment and treatment of adolescents in TASA, but these guidelines are not empirically supported. The proposed study will provide feasibility data on the potential for a large multisite clinical trial comparing medication plus supportive clinical care (MM) vs. cognitive behavior therapy (CBT-TASA) vs. combination treatment (MM+CBT-TASA) for adolescents with depressive disorders and a recent suicide attempt. We propose a three group mixed randomized, controlled/preference trial of 120 depressed adolescent suicide attempters (24 per site) ages 12-18 years. In this design, not all patients will be randomized to one of the treatment conditions; instead patients may choose to be randomly assigned to one of the available treatment conditions or they may choose one of the available treatment conditions. Those patients or families who do not have a treatment preference will be randomly assigned to one of the three treatment conditions. Subjects who enter the study on a stable dose of antidepressant medication will only be eligible to be randomized or to choose the MM or MM+CBT treatment conditions.