Evaluation of the "Coping Long Term with Active Suicide Program"

自杀和自杀未遂是美国的主要公共卫生问题，2009年自杀死亡人数超过36，000人，每年自杀未遂人数超过500，000。尽管近年来我们对许多精神疾病的有效治疗方法的认识有了显著的进步，但这个国家的自杀率并没有大幅下降。尽管自杀具有很高的公共卫生意义，而且我们目前的精神病治疗显然无法影响自杀率，但致力于开发或测试的研究相对较少。 直接针对自杀行为的干预措施。开发和评估新的干预措施以减少自杀行为已被NIMH，CDC和最近发布的2012年国家自杀预防战略确认为优先领域。 在以前的治疗开发赠款的支持下，我们开发了一种新的干预措施，作为社区治疗的辅助措施，专门用于减少高危人群中的自杀行为。这种干预措施，“应对长期主动自杀计划”（CLASP）是一种创新的，基于电话的干预措施，结合了个体心理治疗，病例管理和重要的其他/家庭治疗的元素。CLASP干预的试点数据非常有希望。在出院后的6个月随访期间，因自杀风险而入住精神病医院的患者接受CLASP治疗的自杀企图比接受对照条件的患者少三分之二。 本申请提出进行更大规模的临床试验，评估预防性CLASP干预的效果，以减少 自杀行为更具体地说，我们建议随机分配232例因自杀企图或自杀风险而入住精神病医院的患者，进行CLASP干预或安全性评估和随访评估（SAFE）比较，两者均作为常规社区治疗的替代品。我们建议在主动干预阶段结束时（出院后6个月）以及出院后9个月和12个月时进行随访评估。

DESCRIPTION (provided by applicant): Suicide and attempted suicide are major public health issues in the United States, with suicide accounting for more than 36,000 deaths in the year 2009, and over 500,000 attempt suicide each year. Although recent years have seen significant advances in our knowledge of efficacious treatments for many psychiatric disorders, the suicide rates in this country have not decreased substantially. Despite the high public health significance of suicide and the apparent inability of our current psychiatric treatments to influence suicide rates, there has been relatively little research devoted to developing or testing interventions that directly target suicidal behavior. Developing and evaluating new interventions to reduce suicidal behavior has been recognized as a priority area by NIMH, CDC and the recently released 2012 National Strategy for Suicide Prevention. Supported by previous treatment development grants, we have developed a new intervention as an adjunct to community treatment specifically designed to reduce suicidal behavior among high-risk populations This intervention, "Coping Long Term with Active Suicide Program" (CLASP) is an innovative, telephone based intervention, which combines elements of individual psychotherapy, case management and significant other/family therapy. Pilot data on the CLASP intervention have been quite promising. Patients admitted to a psychiatric hospital due to suicide risk who received CLASP had two-thirds fewer suicide attempts than those receiving a control condition during a six month follow-up following hospital discharge. This application proposes to conduct a larger scale clinical trial evaluating the effects of the adjunctive CLASP intervention to reduce suicidal behavior. More specifically, we propose to randomly assign 232 patients admitted to a psychiatric hospital due to a suicide attempt or suicide risk to either the CLASP intervention or an Safety Assessment and Follow-up Evaluation (SAFE) comparison, both delivered as adjuncts to community treatment as usual. We propose to conduct follow-up assessments at both at the end of the active intervention phase (6 months post-discharge from hospital) and again at 9 and 12 months post discharge.