Development of an Intervention for Suicide Attempters

描述（由申请人提供）：自杀和自杀未遂是美国主要的公共卫生问题，2000年自杀死亡人数超过29,000人，自杀未遂人数超过400,000人。尽管近年来我们在许多精神疾病的有效治疗方面取得了重大进展，但这个国家的自杀率并没有大幅下降。尽管自杀对公共健康的重要性很高，而且我们目前的精神病学治疗显然无法影响自杀率，但致力于开发或测试直接针对自杀行为的干预措施的研究相对较少。这项治疗发展补助金旨在通过为以前有自杀企图的个人制定一个综合的辅助治疗计划来解决这一限制。更具体地说，我们建议制定一项治疗方案，旨在减少高风险样本中随后的自杀行为-在自杀未遂后入住精神病院的成年严重抑郁症患者。这种干预的初步形式，暂定名为“长期应对自杀未遂计划”（CLASP），由三个主要部分组成：a)患者住院期间的三次个人会面，b)与患者及其重要他人的一次面对面会面，以及c)出院后六个月内与患者及其重要他人的一系列预定电话联系。该应用程序的总体目标是进一步发展CLASP干预措施，并收集有关该治疗方案有效性的初步数据。更具体地说，我们建议：1。制定CLASP治疗的综合治疗手册-一种多模式干预，包括认知行为心理治疗和家庭干预的综合治疗策略。2. 制定、实施和评估治疗师培训计划。3. 开发并测试依从性和能力评定量表的可靠性和有效性，以评估治疗师对治疗手册的依从性及其提供治疗的能力。4. 对近期自杀未遂的住院患者样本进行一项随机对照试点研究，以：a)评估拟议治疗的可行性和可接受性；b)评估与常规强化治疗相比，CLASP在减少自杀行为方面的效果大小。这项初步研究将为更大规模的临床试验奠定基础，以评估这种新疗法对这一高危患者群体的自杀效果。

DESCRIPTION (provided by applicant): Suicide and attempted suicide are major public health issues in the United States, with suicide accounting for more than 29,000 deaths in the year 2000 and attempted suicide accounting for over 400,000 hospital admissions. 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. This treatment development grant seeks to address this limitation by developing an integrated, adjunctive treatment program for individuals who have made a previous suicide attempt. More specifically, we propose to develop a treatment program aimed at reducing subsequent suicidal behavior in a high risk sample - adult patients with major depression admitted to a psychiatric hospital following a suicide attempt. In its preliminary format, this intervention, tentatively named the Coping Long- term with Attempted Suicide Program (CLASP), is comprised of three major components: a) three individual meetings while the patient is in the hospital, b) one in-person meeting with the patient and his/her significant other(s) and c) a series of scheduled telephone contacts with the patient and significant other for six months following discharge from the hospital. The overall aim of this application is to further develop the CLASP intervention and to collect preliminary data on the efficacy of this treatment program. More specifically, we propose to: 1. Develop a comprehensive treatment manual for the CLASP treatment - a multi-modal intervention that consists of an integration of treatment strategies from cognitive-behavioral psychotherapies and family interventions. 2. Develop, implement and evaluate a therapist training program. 3. Develop and test the reliability and validity of adherence and competence rating scales to evaluate therapists' adherence to the treatment manual and their competence in delivering the treatment. 4. Conduct a randomized controlled pilot study in a sample of inpatients with a recent suicide attempt to: a) assess the feasibility and acceptability of the proposed treatment, and b) to provide an estimate of effect size of the efficacy of CLASP in reducing suicidal behavior in comparison to Enhanced Treatment As Usual. This pilot study will lay the groundwork for a larger clinical trial evaluating the efficacy of this new treatment for suicide in this high risk group of patients.