Effectiveness Trial of Treatment to Reduce Serious Antisocial Behavior in Emerging Adults with Mental Illness

 描述(申请人提供)：严重的反社会行为，包括刑事犯罪，对社会造成极大的代价。这种行为的发生率在成年初期最高。在患有精神疾病(MI)的新兴成年人(EA)中，反社会行为尤其严重；调查结果表明，大多数患有MI的EA将在25岁之前被捕，大多数人将多次被捕，并因严重指控而被捕。因此，有一个明显的公共卫生需要有效的治疗，以减少严重的反社会行为的急性心肌梗死。令人惊讶的是，无论有无心肌梗死，都没有既定的干预措施能有效地减少EA中的严重反社会行为。对青少年进行有效的反社会行为干预，可解决造成这种行为的全面原因。同样，该团队已经开发并完成了一项针对患有心肌梗塞和严重反社会行为的EAS的明确定义的、针对年龄的干预，该干预解决了EA反社会行为的相关性，并提供了MI治疗。该干预是对成熟有效的青少年反社会行为干预的改编，即多系统治疗(MST)。MST-EA是针对EA的单一来源，该来源针对EA与反社会行为的相关性，包括有利可图的活动(学校、工作、住房和积极的关系)和减少物质使用，部分是通过针对自我调节不力的近端机制。MST-EA还通过减少心肌梗死症状来解决这些相关性。研究小组已经在一项成功完成的基于社区的公开试验(R34MH081374-01，PI：Davis)中确定了这种干预类型的安全性、可行性和初步疗效。这项拟议的研究将严格评估MST-EA在减少严重反社会行为方面的有效性。具体地说，240名患有心肌梗塞和最近从司法机构逮捕或释放的EAS将随机接受MST-EA或照常治疗(TAU)。评估将在0、2、4、6、8、12和16个月完成，并使用抵押品报告和系统记录确认结果数据。第一个目标将是对效果进行全面评估 MST-EA改善最终治疗结果的时间：减少严重反社会行为。第二个目的是评估MST-EA对(A)治疗的关键近端目标(自我调节)和(B)拟议的治疗中间结果(有益活动、物质使用和心肌梗死问题)的影响。最终目的将是确定MST-EA对最终结果的影响是否是其对治疗的近端目标和中期结果的影响的结果。在这个年龄段，目前还没有任何反社会行为治疗被证明有效。这项拟议的研究的最终结果将是减少MI高危人群之一的反社会行为和其他与公共卫生相关的行为(MI症状、药物使用、无家可归、失业)。由于对治疗机制的重视，以及几乎没有侧重于EAs的MI研究，这一创新研究具有推动该领域发展的巨大潜力。

 DESCRIPTION (provided by applicant): Serious antisocial behavior, including criminal offending, is extremely costly to society. Rates of such behavior are highest during emerging adulthood. Antisocial behavior is especially high among emerging adults (EAs) with mental illness (MI); findings suggest the majority of EAs with MI will be arrested by age 25, most with multiple arrests, and for serious charges. Thus, there is a clear public health need for effective treatments to reduce serious antisocial behavior in EAs with MI. Astonishingly, there are no established interventions with evidence of efficacy to reduce serious antisocial behavior among EAs, with or without MI. Effective antisocial behavior interventions in adolescents address the comprehensive causes of that behavior. Similarly, this team has developed and completed research on a well-defined age-tailored intervention for EAs with MI and serious antisocial behavior that addresses the correlates of EA antisocial behavior, and provides MI treatment. The intervention is an adaptation of the well-established effective juvenile antisocial behavior intervention, Multisystemic Therapy (MST). MST-EA is a single source that targets the EA correlates of antisocial behavior, including gainful activity (school, work, housing, and positive relationships) and reduced substance use, in part by targeting the proximal mechanism of poor self-regulation. MST-EA also addresses these correlates through reducing MI symptoms. The investigative team has already established the safety, feasibility, and preliminary efficacy of thi type of intervention in a successfully completed community-based open trial (R34MH081374-01, PI: Davis). The proposed study will rigorously evaluate the effectiveness of MST- EA for reducing serious antisocial behavior. Specifically, 240 EAs with MI and recent arrests or release from justice facilities will be randomized to receive MST-EA or Treatment as Usual (TAU). Assessments will be completed at months 0, 2, 4, 6, 8, 12, and 16, with confirmation of outcome data using collateral reports and system records. The first aim will be to evaluate the effect over time of MST-EA for improving the ultimate outcome of treatment: reduced serious antisocial behavior. The second aim is to evaluate the effect of MST-EA on (a) the key proximal target of treatment (self-regulation) and (b) the proposed intermediate outcomes of treatment (gainful activity, substance use, and MI problems). The final aim will be to determine whether MST-EA's effect on the ultimate outcome is the result of its effect on the proximal target and intermediate outcomes of treatment. There is a current absence of any antisocial behavior treatments with demonstrated efficacy in this age group. The ultimate effect of the proposed research would be decreased antisocial behavior and other public health-related behaviors (MI symptoms, substance use, homelessness, unemployment) among one of the highest-risk population of individuals with MI. With an emphasis on treatment mechanisms and the near absence of MI research focused on EAs, this innovative research has high potential to advance the field.