Effectiveness trial of youth suicide prevention delivered by teen peer leaders

描述（由申请人提供）：该项目响应了以下需求：（1）对预防青少年自杀的干预措施进行科学严格的评估，以及（2）适合农村和服务不足社区的基于学校的自杀预防计划，这些社区缺乏心理健康服务。在美国，10 - 24奥尔兹青少年的自杀死亡人数超过所有自然原因的总和;每年有5 - 9%的青少年试图自杀，70万人需要医疗照顾。在大多数农村地区，青少年自杀率是美国全国平均水平的2 - 10倍。 该提案旨在为一项随机对照试验寻求RO 1资金，以评估力量来源（SoS）干预在降低农村社区青少年自杀未遂率方面的有效性。SoS在高中生中建立社会生态保护影响，以减少弱势青年自杀的可能性，并将自杀青年与学校和社区中有能力的成年人联系起来。经过培训的“同侪意见领袖”通过开展一系列明确的信息传递活动，并持续进行成人指导，改变了整个学校学生在接受自杀、寻求帮助和青年与成人沟通方面的规范。这种方法利用了青少年同龄人的重大影响力，这种影响力足以影响吸毒、性行为和其他健康行为。我们已经完成了为大规模试验准备SoS的工作，包括在18所学校中使用随机设计进行初步研究，表明干预措施修改了全校学生关于自杀和寻求帮助的规范，其中自杀青年发生的变化最大。 在这项为期5年的研究中，纽约和北达科他州的36所农村高中将被随机分配到即时SoS或等待名单控制条件。我们将在18个月内对学校的学生进行调查，以（1）比较自我报告的自杀企图的干预和控制水平，（2）确定对低风险和高风险群体的影响差异，（3）从我们的干预因果模型中测试SoS对减少自杀企图的影响的多个假设介质，（4）在一部分学校中使用社会网络方法，以确定SoS影响的网络中介，点对点信息的传播程度，并评估当前识别学生同侪领导者的策略的效率。该项目可以通过准备一种具有成本效益的干预措施来产生积极的公共卫生影响，这种干预措施可以在不同的社区安全实施，并有效减少青少年的自杀行为。 公共卫生相关性：这项拟议的5年项目可以通过准备力量来源（SoS），一个以学校为基础的自杀预防干预措施，作为一个具有成本效益的计划，可以在不同的社区安全实施，并有效地减少青少年自杀行为的扩展，产生积极的公共卫生影响。拟议的研究还可以有助于知识，以加强社会生态保护的影响，在整个人口的高中学生的同侪意见领袖，改变规范的学生通过他们的学校，减少自杀行为。

DESCRIPTION (provided by applicant): This project responds to the need for (1) scientifically rigorous evaluations of interventions to prevent suicide in adolescents, and for (2) school-based suicide prevention programs that are suitable for rural and underserved communities where there is a scarcity of mental health services. Suicide accounts for more deaths among 10 - 24 year olds in the US than all natural causes combined; each year 5 - 9% of adolescents attempt suicide and 700,000 require medical attention. In most rural regions, adolescent suicide rates are 2 - 10 times above the US national average. This proposal seeks RO1 funding for a randomized controlled trial to evaluate the effectiveness of the Sources of Strength (SoS) intervention in reducing rates of attempted suicide among adolescents in rural communities. SoS builds social-ecological protective influences across a full population of high school students to reduce the likelihood that vulnerable youth will become suicidal and connects suicidal youth to capable adults at school and in the community. Trained 'peer opinion leaders' change the norms of students throughout their schools regarding the acceptability of suicide, help-seeking and youth-adult communication by conducting a set of well-defined messaging activities with ongoing adult mentoring. This approach draws on the major influence of adolescent peers that is powerful enough to affect drug use, sexual practices and other health behaviors. We have completed work to prepare SoS for a large scale trial, including conducting a preliminary study using a randomized design in 18 schools showing that the intervention modifies the norms of students school-wide about suicide and help seeking, with the largest changes occurring among suicidal youth. For the proposed 5-year study, 36 rural high schools in New York and North Dakota will be randomly assigned to immediate SoS or wait-list control conditions. We will survey students in the schools over 18 months to (1) compare intervention and control levels of self-reported suicide attempts, (2) determine differences in impact for low- and high-risk groups, (3) test multiple hypothesized mediators of SoS impact on reducing suicide attempts from our intervention causative model, (4) use social network methods in a subset of schools to identify network mediators of SoS impact, the extent of dissemination of peer-to-peer messages, and evaluate the efficiency of the current strategy for identifying student peer leaders. This project can have a positive public health impact through the potential to prepare a cost-effective intervention that can be implemented safely in diverse communities and is effective in reducing suicidal behaviors among adolescents. PUBLIC HEALTH RELEVANCE: This proposed 5-year project can have a positive public health impact by preparing Sources of Strength (SoS), a school-based suicide prevention intervention, for expansion as a cost-effective program that can be implemented safely in diverse communities and is effective in reducing suicidal behaviors among adolescents. The proposed study can also contribute to knowledge needed to strengthen social-ecological protective influences across a full population of high school students by peer opinion leaders to change the norms of students through their schools and reduce suicidal behaviors.