Tailored Activation in Primary Care to Reduce Suicide Behaviors in Middle Aged Men

 描述(由申请人提供)：几乎所有旨在减少35岁至男性(迄今为中年男性)自杀行为的努力都是针对普通人群(例如，经济能力限制)或专门的精神健康或急性护理(例如，医院)。但关于 所有自杀死亡的中年男子中，有一半在死亡后一个月内被初级保健提供者(PCP)看到，这表明了以初级保健为基础的预防的价值，以补充其他环境中的战略。目前，以初级保健为基础的预防工作面临的障碍是，许多有自杀倾向的中年男子不去初级保健中心就诊，而且，由于与社会性别有关的规范(例如，坚韧)、耻辱、关于谈论自杀会增加风险的虚假担忧、相互竞争的时间要求以及缺乏应对积极反应的资源，自杀的主题很少被提及。以PCP为目标的教育干预增加了对自杀男性的发现，但并不一致地影响自杀行为。自杀行为更有可能通过循证后续护理(EBFC：支持性后续接触，对于抑郁症患者，合作护理)来减少。然而，只有当高危男性去看识别自杀风险并提供护理的初级保健医生，并接受治疗时，这种护理才能有效。因此，迫切需要研究激活高危中年男性以发出接受自杀讨论和护理的信号的效果，促使PCP询问并转介到一种大多数做法都可行的EBFC形式。同样迫切的是对可行的EBFC的需求；吸收是有限的，因为大多数实践缺乏现场CMS和精神病学家提供它。 在这项建议中，我们将招募有积极自杀想法的中年男性参加随机对照试验，以检查他们的PCP前期是否使用多媒体激活预防自杀(MAP)for Men量身定制的交互式计算机程序，该程序与集成电话EBFC(与TEBFC相关的注意控制暴露)相关联，在3个月内减少自杀准备行为(主要结果，对自杀企图和死亡的预测)和意念。我们将从我们的研究证实的抑郁症激活计划中完善男性地图，纳入我们将在自杀预防方面征求广泛利益相关者的意见，指导 通过经验支持的行为理论。

 DESCRIPTION (provided by applicant): Nearly all efforts to reduce suicide behaviors in men aged 35-64 (heretofore middle-aged men) have been targeted to the general population (e.g., means restriction) or to specialty mental health or acute care (e.g., hospital) settings. Yet about half of all middle-aged men who die by suicide are seen by a primary care provider (PCP) within a month of dying, suggesting the value of primary care-based prevention, to complement strategies in other settings. Current impediments to primary care-based prevention are that many suicidal middle-aged men do not visit a PCP, and among those who do the topic of suicide is rarely broached, due to societal gender-linked norms (e.g., toughness); stigma; spurious concerns that talking about suicide increases risk; competing time demands; and lack of resources to cope with positive responses. PCP-targeted educational interventions increase detection of suicidal men, but inconsistently affect suicide behaviors. Suicide behaviors are more likely to be reduced by evidence-based follow-up care (EBFC: supportive follow-up contact and, for depressed patients, collaborative care). However, such care can only be effective if at-risk men visit a PCP who identifies suicide risk and offers the care, and the men accept it. Thus, there is a pressing need to study the effects of activating at risk middle-aged men to signal receptiveness to suicide discussion and care, prompting PCP inquiry and referrals to a form of EBFC that is feasible for most practices to implement. Also pressing is the need for feasible EBFC; uptake is limited, as most practices lack on-site CMs and psychiatrists to offer it. In this proposal, we will enroll middle-aged men with active suicide thoughts in a RCT to examine whether their pre-PCP visit use of the Multimedia Activation to Prevent Suicide (MAPS) for Men tailored interactive computer program, linked with integrated telephone EBFC (TEBFC) (vs. attention control exposure linked with TEBFC), reduces suicide preparatory behaviors (primary outcome, predictive of suicide attempts and deaths) and ideation over 3 months. We will refine MAPS for Men from our research- proven depression activation program, incorporating input we will solicit from a wide array of stakeholders in suicide prevention, guided by empirically-supported behavioral theories.