Family Based Intervention for Adolescent Suicide Attempters

说明（由申请人提供）：减少青少年的自杀和自杀企图是2010年健康人促进健康和预防疾病的两项目标。尽管青少年的发病率和死亡率与自杀企图有关，但我们缺乏经验支持的治疗策略和关于最佳做法的共识。本提案旨在通过制定、试行和评估一项专门针对预防重复和潜在致命自杀企图的干预方案，解决这一关键的公共卫生问题。这项工作包括两个阶段。在第一阶段，我们将对25名青少年制定和预测试干预手册和方案、培训和质量保证方案以及遵守措施。在第二阶段，我们将随机分配60名青少年到安全干预组（n=30）或常规护理组（n=30）。安全干预是一种个性化的干预策略，它整合了：1)以家庭和社区为基础的干预，旨在动员家庭和社区网络，支持青少年的安全、适应性行为和生活理由，并减少导致自杀的因素；2)以降低自杀率和防止重复自杀企图为重点的认知行为治疗模块；3)个性化护理联动策略，将青少年与所需的服务和资源联系起来。在3个月和6个月的随访评估中，由对干预条件不知情的评估者监测结果。主要结局是：住院；重复自杀企图的发生率；青少年和家长对心理健康服务的满意度。次要结局是：青少年抑郁；绝望;活着的理由；与心理健康有关的生活质量；以及父母/照顾者的情感健康。我们研究了治疗反应的潜在调节因素（如抑郁、年龄、性别、种族）和调节因素（生活原因、绝望、抑郁症状、家庭冲突、社会支持）。为了预测在常规实践条件下干预的可行性和有效性以及最终的社区采用的关键问题，我们在治疗发展过程中包括了来自社区心理健康项目的合作伙伴。该项目旨在进一步发展并对“安全计划”进行初步评估，这是一项旨在预防青少年自杀和自杀未遂的干预措施。自杀是青少年死亡的第三大原因，减少青少年的自杀和自杀企图是我国促进健康和预防疾病的两项国家目标（2010年健康人，疾病预防和促进健康办公室，2000年）。

DESCRIPTION (provided by applicant): Reducing suicide and suicide attempts in adolescents are two of the health promotion and disease prevention objectives of Healthy People 2010. Despite the morbidity and mortality associated with suicide attempts in adolescents, we lack empirically supported treatment strategies and consensus regarding best practices. This proposal aims to address this critical public health problem by developing, piloting, and evaluating an intervention protocol aimed specifically at preventing repeat and potentially lethal suicide attempts. The work involves two phases. During Phase 1, we will develop and pretest the intervention manuals and protocol, training and quality assurance protocols, and adherence measures with 25 youth. In Phase 2, we will randomly assign 60 youth to the SAFETY Intervention (n=30) or Usual Care (n=30). The SAFETY Intervention is an individually tailored intervention strategy that integrates: 1) family and community based interventions aimed at mobilizing family and community networks that support youth safety, adaptive behavior, and reasons for living, and decreasing factors contributing to suicidality; 2) cognitive-behavioral treatment modules that focus on decreasing suicidality and preventing repeat suicide attempts; and 3) an individualized care linkage strategy that links youth to needed services and resources. Outcomes are monitored at 3- and 6-month follow-up assessments, by evaluators who are blinded to intervention condition. Primary outcomes are: hospitalizations; incidence of repeat suicide attempts; and youth and parent satisfaction with mental health services. Secondary outcomes are: youth depression; hopelessness; reasons for living; mental health related quality of life; and parent/caregiver emotional well being. We examine potential moderators (e.g. depression, age, gender, ethnicity) and mediators (reasons for living, hopelessness, depressive symptoms, family conflict, social support) of treatment response. To anticipate key issues that are important for intervention feasibility and effectiveness under usual practice conditions and eventual community adoption, we include partners from community mental health programs in the treatment development process. This project aims to further develop and conduct a preliminary evaluation of the SAFETY Program, an intervention aimed at preventing suicide and suicide attempts in adolescents. Suicide is the third leading cause of death among adolescents and reducing suicide and suicide attempts in adolescents are two of our national health promotion and disease prevention objectives (Healthy People 2010, Office of Disease Prevention and Health Promotion, 2000).