Predicting and Preventing Suicidal Ideation among High-Risk Sexual and Gender Minority Adolescents

项目总结 性少数群体和性别少数群体(SGM)青少年自杀风险增加。约1/3的SGM 青少年报告曾试图自杀，而非SGM青少年的这一比例为十分之一。SGM青少年是 被认为容易自杀，因为他们必须与典型的青春期压力源一起谈判 接受SGM身份，这可能涉及管理暴露于与污名相关的压力源 包括外部应激源(例如，欺凌)和导航繁重的内部心理应激源(例如，身份 隐藏)。这个拟议的K01项目的首要目标是名为SPIRIT(真实自杀预测)的项目。 时间)，是为了检查与污名相关的压力源(例如，欺凌、身份隐瞒)的影响，以及 最近SGM青少年自杀意念的普遍自杀前兆(如绝望) 因急性自杀入院治疗。我将利用最先进的实时移动监控方法 生态瞬时评估(EMA)和全球定位系统(GPS)数据，以追求 项目的三个目标：(目标1)开发一种EMA+GPS评估方法，能够捕获两个自我 通过SGM青少年近期住院患者的焦点小组报告和基于地点的耻辱暴露； (目的2)通过一项为期28天的研究，考察近期住院的SGM青少年自杀意念的先兆。 EMA+GPS研究；以及(目标3)开发和完善即时适应干预(JITAI)的组成部分 以SGM青少年自杀风险为目标，来自目标2参与者的焦点小组的定性数据 并深入访谈临床医生和吉泰专家。来自项目精神的证据将奠定基础 为了让NIMH R01进一步测试针对高危SGM的经验性自杀预防吉泰 青少年。为了成功地进行拟议的研究项目，我将：(1)接受创新方面的培训 微观纵向研究方法，包括EMA+GPS技术；(2)发展 在临床人群中进行负责任的研究和解决安全问题方面的专业知识；以及(3) 掌握开发经验丰富的吉泰的技能，以降低自杀风险。通过参与指导计划 与John Pachankis博士(主要导师)以及由共同导师和合作者组成的专家团队的研究，网址为 耶鲁大学和其他地方，并参加课程、研讨会、研讨会、科学会议和 定期召开导师会议，我将培养成功实施建议的必要技能 从事研究活动，满足我成为一名独立科学家的长期职业目标。耶鲁大学 提供丰富的智力和实践资源，跨学科的研究和培训环境，以及 专业发展和协作机会，以支持职业生涯早期的研究人员启动 他们的独立研究生涯。建议的K01将为我提供培训、指导和 为建立一个独立的研究计划所需的受保护时间，该计划侧重于SGM差异和 通过严谨的科学探究和干预发展来预防自杀。

PROJECT SUMMARY Sexual and gender minority (SGM) adolescents are at increased risk for suicide. Approximately 1 in 3 SGM adolescents report having attempted suicide compared to 1 in 10 non-SGM adolescents. SGM adolescents are thought to be vulnerable to suicide because they must negotiate typical stressors of adolescence alongside coming to terms with an SGM identity, which can involve managing exposure to stigma-related stressors including external stressors (e.g., bullying) and navigating taxing internal psychological stressors (e.g., identity concealment). The overarching goal of this proposed K01, entitled Project SPIRiT (Suicide Prediction In Real- Time), is to examine the influence of stigma-related stressors (e.g., bullying, identity concealment) and universal suicide precursors (e.g., hopelessness) on suicidal ideation among SGM adolescents recently hospitalized for acute suicidality. I will utilize state-of-the-art real-time mobile monitoring methods incorporating both ecological momentary assessment (EMA) and global positioning system (GPS) data to pursue the project’s three aims: (Aim 1) develop an EMA+GPS assessment approach capable of capturing both self- reported and place-based exposure to stigma through focus groups with SGM adolescent recent inpatients; (Aim 2) examine precursors to suicidal ideation among SGM adolescent recent inpatients through a 28-day EMA+GPS study; and (Aim 3) develop and refine components of a just-in-time adaptive intervention (JITAI) targeting SGM adolescent suicide risk, informed by qualitative data from focus groups with Aim 2 participants and in-depth interviews with clinicians and JITAI experts. Evidence from Project SPIRiT will lay the groundwork for an NIMH R01 to further test an empirically informed suicide prevention JITAI for high-risk SGM adolescents. To successfully conduct the proposed research project, I will: (1) obtain training in innovative approaches to micro-longitudinal research methodology, including EMA+GPS technology; (2) develop expertise in conducting responsible research with clinical populations and addressing safety concerns; and (3) acquire skills in developing an empirically informed JITAI to reduce suicide risk. By engaging in mentored research with Dr. John Pachankis (primary mentor) and an expert team of co-mentors and collaborators at Yale University and beyond, and participating in coursework, seminars, workshops, scientific conferences, and regular mentorship meetings, I will develop the skills necessary to successfully carry out the proposed research activities and meet my long-term career goal of becoming an independent scientist. Yale University offers rich intellectual and practical resources, an interdisciplinary research and training environment, and professional development and collaborative opportunities to support early-career investigators in launching their independent research careers. The proposed K01 will provide me with the training, mentorship, and protected time necessary to establish an independent program of research focused on SGM disparities and suicide prevention through rigorous scientific inquiry and intervention development.