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因素，在低- 资源配置。母亲身份既是自杀想法和行为的保护因素，也是自杀行为的风险因素。在 在围产期，妇女产生自杀意念的风险增加，遭受暴力的比率也更高， 暴力致死鉴于自杀率上升，围产期对母亲和儿童的重要性， 越来越多的传播任务转移计划，以治疗常见的精神障碍，有关键和紧迫的 需要在这些方案中纳入自杀检测和转诊的实施战略。而 任务转移的心理健康干预措施已经培训了同伴社区成员， 在获得临床护理的机会有限的地方，加强干预措施，同伴仍然是一种未开发的资源，可以提供 在最需要的地方提供自杀预防支持。该奖项的目的是扩大 候选人的专业知识，进行有关自杀预防研究的独立临床试验，重点是 在资源匮乏、需求旺盛的环境中整合社区提供的检测和响应。通过 来自专家团队的结构化指导，课程，研讨会和会议出席，候选人 将开发自杀预防研究的新能力，包括：（1）纵向定量培训 罕见事件的分析（2）应用科学方法和研究设计来研究自杀 预防干预措施;（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资助的独立调查员。唐娜医生 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达到这些目标。拟议的研究将 (1)研究随着时间的推移，反复出现的自杀意念对母亲的流行病学和健康影响，（2） 描述自杀意念的关键特征，并最终确定研究的干预方案组成部分 （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 预防包（SuPP）在现有的任务转移抑郁症干预。K 01奠定了 为未来的R 01奠定基础，以扩展多层次自杀预防策略的一揽子计划， 纳入社区心理健康计划，特别是针对生活在低收入国家的个人， 资源配置。由于该模型的设计易于适应和整合，我们预计结果 对于所有希望改善人口健康和心理健康服务的研究人员来说， 弱势群体。

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.