Opportunities for suicide prevention integration into task-shifted mental health interventions in low-resourced contexts

摘要 自杀是全球死亡率的主要贡献者，在低死亡率国家，自杀率保持稳定或上升。 资源设置。母亲身份既是自杀念头和行为的保护性因素，也是危险因素。在 围产期，妇女有自杀念头的风险增加，经历更高的暴力和 暴力致死。鉴于自杀率不断上升，围产期对母亲和孩子的重要性，以及 越来越多地传播任务转移方案来治疗常见的精神障碍，这是至关重要和紧迫的 需要将自杀检测和转介的实施战略纳入这些计划。而当 任务转移的心理健康干预已培训同龄人社区成员成功地提供Low 强度干预在获得临床护理的机会有限的情况下，同伴仍然是一种未开发的资源，可以提供 在最需要的环境中提供自杀预防支持。这一奖项的目标是扩大 候选人在进行与自杀预防研究相关的独立临床试验方面的专业知识侧重于 在低资源、高需求的环境中整合社区交付的检测和响应。穿过 来自专家团队、课程、研讨会和出席会议的结构化指导，候选人 将在自杀预防研究方面培养新的能力，包括：(1)纵向量化培训 罕见事件分析(2)应用于自杀的实施科学方法和研究设计 预防干预措施；和(3)临床试验管理技能，包括预防自杀的道德行为 在资源紧张的情况下进行研究，成为NIH资助的独立研究员。唐娜博士 Spiegelman，Joanna Maselko，Atif Rahman，Paul Pfeiffer和Byron Powell(与巴基斯坦顾问一起 委员会)将指导和建议候选人实现这些目标。拟议的研究将 (1)研究长期反复出现的自杀意念对母亲的流行病学和健康影响，(2) 描述自杀意念的主要特征，并最终确定研究的干预方案组成部分 背景，以及(3)进行试点临床试验，以评估实施自杀的可行性和可接受性 预防套餐(Supp)在现有的任务型抑郁症干预中。这款K01奠定了 为未来的R01奠定基础，以扩展多层次自杀预防战略的一揽子计划，这些战略可以 融入以社区为基础的心理健康计划，特别是针对生活在低收入家庭的个人 资源设置。由于该模型的设计易于调整和集成，因此我们预计会有结果 对所有希望改善人口健康和精神健康服务的研究人员来说都是有价值的 处境不利的环境。

ABSTRACT Suicide is a leading contributor to global mortality and rates have remained steady, or increased, in low- resourced settings. Motherhood is both a protective and risk factor for suicidal thoughts and behaviors. In the perinatal period, women have increased risk for suicidal ideation and experience higher rates of violence and violent death. Given rising suicide rates, the importance of the perinatal period for both mother and child, and growing dissemination of task-shifting programs to treat common mental disorders, there is critical and urgent need to incorporate implementation strategies for suicide detection and referral within these programs. While task-shifted mental health interventions have trained peer community members to successfully deliver low intensity interventions where access to clinical care is limited, peers remain an untapped resource to provide suicide prevention support in settings where it is needed most. The goal of this award is to broaden the candidate’s expertise to conduct independent clinical trials related to suicide prevention research focused on the integration of community-delivered detection and response in low-resourced, high need, settings. Through structured mentorship from an expert team, coursework, workshop, and conference attendance, the candidate will develop new competencies in suicide prevention research, including: (1) quantitative training in longitudinal analysis for rare events (2) implementation science methods and research design to apply to suicide prevention interventions; and (3) clinical trial management skills, including ethical conduct of suicide prevention research in resource strained contexts, to become a NIH-funded independent investigator. Drs. Donna Spiegelman, Joanna Maselko, Atif Rahman, Paul Pfeiffer, and Byron Powell (alongside a Pakistani advisory committee) will mentor and advise the candidate to meet these objectives. The proposed research will (1) examine the epidemiology and health impacts of recurrent suicidal ideation on mothers over time, (2) characterize key features of suicidal ideation and finalize intervention package components for the study context, and (3) conduct a pilot clinical trial to assess the feasibility and acceptability of implementing a Suicide Prevention Package (SuPP) within an existing task-shifted depression intervention. This K01 lays the groundwork for a future R01 to scale a package for multi-level suicide prevention strategies that can be integrated into community based mental health programs, particularly targeting individuals living in low- resourced settings. As the model is designed to be easily adapted and integrated, we anticipate the findings will be valuable for all researchers looking to improve population health and mental health services in disadvantaged settings.