Study 1: Screening Guru

研究一，《筛选大师》摘要 青少年自杀率在过去十年里增加了20%以上，现在是第二大自杀率 青少年死亡的主要原因。抑郁是导致自杀念头的最重要因素， 12-17.11岁青少年自杀未遂和自杀死亡。在中国进行心理健康问题筛查 普遍的，特别是抑郁症和自杀，是国家的优先事项。即使常规筛查是 实施后，治疗启动率较低。开始抑郁症治疗的一个关键障碍是 青少年和他们的父母(S)认为有必要进行心理健康治疗。对心理健康的感知需求 护理服务是服务使用的已知预测指标，但当抑郁不是表现时，可能较低 关注，而不是在例行筛查问卷中确定。该项目旨在提高 初级保健提供者的适当转介和筛查呈阳性的青少年的治疗启动 对于抑郁或自杀意念：1)评估青少年及其父母在坚持到底方面的障碍 在治疗开始前提供临床医生建议的护理；以及2)为临床医生提供决策- 为青少年的临床表现、治疗提供个性化的支持建议 偏好和障碍。这将通过三个具体目标来实现。目标1是开发一种 自动化决策支持系统(DSS)将指导初级保健提供者实现个性化 对出现抑郁症状和自杀风险的青少年的治疗建议 办公室会面的时间。目标2是测试DSS的有效性，采用阶梯式楔形设计，在 在青少年试点试验(N=120)中提高初级保健提供者的个性化转诊率 12-17.11岁在常规初级保健就诊期间筛查抑郁症和/或自杀呈阳性的人。目标3 探讨DSS对服务利用率和症状减轻的影响。该项目具有创新性。 由于目前还没有用于评估抑郁青少年的初级保健医生的支持工具，该工具集成了 使用自适应筛查的自杀风险信息、抑郁的严重程度以及患者和父母 为初级保健医生提供个性化建议的动机、障碍和治疗偏好 病人。这项研究有可能通过减少变异性来改善抑郁症筛查后的护理 在儿科医生的治疗建议中，并提高儿科医生对潜在护理障碍的认识，以便 提供反映患者临床需求的转诊，并增加患者对 推荐的护理。

Study One, “Screening Guru” Abstract The adolescent suicide rate has increased by more than 20% in the past decade and is now the second leading cause of death for adolescents. Depression is the single most important contributor to suicidal ideation, attempt, and death by suicide among adolescents aged 12-17.11. Screening for mental health problems in general, and for depression and suicidality in particular, is a national priority. Even when routine screening is implemented, initiation of treatment is low. One critical barrier to starting depression treatment is whether adolescents and their parent(s) perceive a need for mental health treatment. Perceived need for mental health care services is a known predictor of service use, but may be low when depression is not the presenting concern but rather is identified on a routine screening questionnaire. This project seeks to increase the rate of appropriate referrals by primary care providers and treatment initiation among adolescents who screen positive for depression or suicidal ideation by: 1) assessing adolescents’ and their parents’ barriers to following through with clinician-recommended care prior to the start of treatment; and 2) providing clinicians with decision- support recommendations that are personalized to the adolescent’s clinical presentation, treatment preferences, and barriers. This will be accomplished through three specific aims. Aim 1 is to develop an automated decision-support system (DSS) that will guide primary care providers in making personalized treatment recommendations to adolescents presenting with symptoms of depression and risk for suicide at the time of the office encounter. Aim 2 is to test the effectiveness of the DSS, using a stepped wedge design, at increasing primary care providers’ rate of personalized referrals in a pilot trial (N = 120) of adolescents aged 12-17.11 years who screen positive for depression and/or suicidality during a routine primary care visit. Aim 3 is to explore the impact of the DSS on service utilization and symptom reduction. This project is innovative because there currently is no support tool for PCPs assessing depressed adolescents, the tool integrates information about suicidal risk using an adaptive screen, severity of depression, and patient and parent motivation, barriers, and treatment preferences to provide the PCP with a personalized recommendation for the patient. The study has the potential to improve care following depression screening by reducing variability in PCPs’ treatment recommendations, and increasing PCPs’ awareness of potential barriers to care so as to provide a referral that reflects the patient’s clinical needs and also increases patients’ engagement with recommended care.