Pilot Study of Online Interventions for Population-Based Suicide Prevention

描述（由申请人提供）：降低自杀未遂和自杀的风险是公共卫生的优先事项。在美国，每年有36，000人死于自杀，这是我们 全国第十大死因在过去的20年里，自杀率并没有大幅下降。迄今为止，预防工作的重点是初级（例如公共服务公告）和三级（例如自杀未遂后的干预）方法。二级预防或指示性预防相对未被探索。二级预防需要准确的筛查方法和有效的干预措施。这些基本要素现已具备。我们最近的研究表明，对PHQ抑郁量表中自杀意念项目的反应是随后自杀企图和死亡的有力预测因素。电子医疗记录中的PHQ的可用性为准确的人群水平筛查创造了机会。辩证行为疗法（DBT）在预防临床人群自杀企图方面具有三级疗效的有力证据。简短的外展三级干预措施，如关怀信息，有一些证据可以防止自杀企图。这些临床或三级预防干预措施为建立二级预防计划提供了最佳证据。由此产生的程序可以链接到电子医疗记录中的人群水平筛查数据。研究计划的第一个目标是适应 DBT和关怀信息，以适应适合在医疗保健环境中可识别的大量高危患者的交付模式。第二个目标是评估这些替代性在线自杀和自伤二级预防计划的可行性，可接受性和安全性。在线交付模式是合适的，因为它们是可扩展的，并且可以安全，廉价地提供，并利用医疗保健中的现有系统。将评估三种简短的在线干预措施：关怀电子邮件（CE）; CE + DBT在线计划; CE + DBT在线计划+教练。每项干预措施将补充通过在门诊初级保健和心理健康访视中收集的PHQ抑郁量表确定的高危患者的常规护理。干预内容将从DBT和关怀信息的原则中提取。研究设计将是附加的，以检查在大规模交付所需资源方面差异很大的替代干预模式。然而，这些干预措施所需的资源比亲自或电话干预措施少得多。该项目将涉及干预可行性（预测试，N=60）和可接受性和安全性测试（试点，N=400）。可接受性将通过患者干预参与水平（需要大规模试点样本）和患者的定性/形成性干预反馈进行评估。将通过与仅接受持续常规护理的患者相比，干预条件下病历中的精神病住院率和自伤诊断来评估安全性。试点研究的结果将为全面有效性试验的设计提供信息，该试验将检查这些干预措施中的一种或多种对自杀未遂和/或自杀死亡风险的影响。

DESCRIPTION (provided by applicant): Reducing the risk of suicide attempt and suicide is a public health priority. In the United States, 36,000 people die annually from suicide and it is our nation's 10th leading cause of death. There has been no substantial decrease in suicide for the past two decades. Prevention efforts to date have focused on primary (e.g. public service announcements) and tertiary (e.g. interventions following suicide attempt) methods. Secondary or indicated prevention has been relatively unexplored. Secondary prevention requires both accurate screening methods and effective interventions. These essential elements are now available. Our recent research demonstrates that responses to the suicidal ideation item of the PHQ depression scale are a powerful predictor of subsequent suicide attempt and death. Availability of the PHQ in electronic medical records creates an opportunity for accurate population-level screening. Dialectical behavior therapy (DBT) has strong evidence of tertiary efficacy for preventing suicide attempts in clinical populations. Brief outreach tertiary interventions such as caring messages have some evidence for preventing suicide attempts. These clinical or tertiary prevention interventions provide the best available evidence for use in building secondary prevention programs. Resulting programs could then be linked to population-level screening data in electronic medical records. The first goal of the research plan is to adapt DBT and caring messages to fit delivery models suitable for the large numbers of at-risk patients identifiable in healthcare settings. The second goal is to evaluate the feasibility, acceptability, and safety of these alternative online suicide and self-injury secondary prevention programs. Online delivery models are suitable because they are scalable and can be provided securely, cheaply, and utilizing existing systems in healthcare. Three brief online interventions will be evaluated: caring email (CE); CE + DBT online program; and CE + DBT online program + coach. Each intervention will supplement usual care among high- risk patients identified via PHQ depression scales collected at outpatient primary care and mental health visits. Intervention content will be drawn from the principles of DBT and caring messages. The study design will be additive in order to examine alternative intervention models that vary widely in resources required for large- scale delivery. However, these interventions will require vastly fewer resources than in-person or telephone interventions. The project will involve intervention feasibility (pretesting, N=60) and acceptability and safety testing (pilot, N=400). Acceptability wll be assessed by patient intervention engagement levels (requiring the large pilot sample) and qualitative/formative intervention feedback from patients. Safety will be assessed via rates of psychiatric hospitalizations and self-injury diagnoses in the medical record in the intervention conditions compared to those receiving just continued usual care. Results of the pilot study will inform the design of a full-scale effectiveness trial examining the impact of one or more of these interventions on risk of suicide attempt and/or suicide death.