Effectiveness trial of youth suicide prevention delivered by teen peer leaders

描述（由申请人提供）：本项目满足以下需求：(1)对预防青少年自杀的干预措施进行科学严格的评估；(2)适合农村和缺乏心理健康服务的社区的以学校为基础的自杀预防计划。在美国，10 - 24岁的年轻人中，自杀的死亡人数超过了所有自然原因的总和；每年有5 - 9%的青少年企图自杀，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。本提案为一项随机对照试验寻求RO1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在整个高中学生群体中建立社会生态保护影响，以减少弱势青年自杀的可能性，并将有自杀倾向的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“同伴意见领袖”通过在持续的成人指导下开展一系列明确定义的信息传递活动，改变了学生在整个学校对自杀、寻求帮助和青少年与成人交流的可接受性的规范。这种方法利用了青少年同伴的主要影响，这种影响足以影响吸毒、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所学校进行了一项随机设计的初步研究，表明干预改变了全校学生关于自杀和寻求帮助的规范，其中最大的变化发生在有自杀倾向的青少年中。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立即SoS或等候名单控制条件。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)确定低风险群体和高风险群体的影响差异，(3)从我们的干预因果模型中检验SoS对减少自杀企图影响的多个假设中介，(4)在学校的一个分支中使用社会网络方法来确定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伴领导的策略的效率。该项目有可能制订一种具有成本效益的干预措施，可在不同社区安全实施，并能有效减少青少年的自杀行为，从而对公共卫生产生积极影响。

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.