Suicide Prevention with Substance Using Youth Experiencing Homelessness

项目摘要/摘要 虽然关于利用无家可归青年(YEH)的物质的研究正在增加，但缺乏 关于对这些青年进行有效预防干预的信息。这一点非常令人担忧，因为 研究表明，66%到89%的叶有精神健康障碍(Cauce等人，2004年)，68%的人报告说 至少一次自杀未遂(Gewitz等人，2020年)。事实上，自杀是叶氏家族的首要死因 (Rotheram-Borus&Milburn，2004；Yoder等人，2010)。在那些试图自杀的人中，平均 据报道，有6.2次自杀企图，终生自杀意念率从14%到66.5%不等(Yoder等人，2010年) 没有明确证据表明对叶诗文进行了有效的干预。本研究使用了一般认知理论(Beck， 1967)，辅以来自两个特定自杀理论模型的概念，以指导我们的干预和 概念变革模型。我们的目标是测试延长认知疗法的实施和吸收的策略 是的干预。之前的研究关注的是与服务相关的年轻人，但研究表明，大多数街道 生活着的YH无法获得旨在帮助他们的服务(Kelly&Caputo，2007)。我们克服了先前的抽样 除了通过当地的服务连接的青年之外，还通过招募服务中断的青年来限制 临时收容中心。因此，三百种使用叶的物质最近有自杀想法或最近 自杀未遂将随机分配到预防自杀认知疗法(CTSP)+服务 SAU组(N=150)或单纯SAU组(N=150)。CTSP此前曾通过一种 区域技术合作试点可行性研究(Slesnick等人，2020年；Wu等人，2020年)。SAU包括外展、宣传和 服务链接，这是为无家可归者提供服务的机构提供的典型服务(Ober 等人，2012年)。后续评估将在基线后3、6、9和12个月进行。它是 假设接受CTSP+SAU治疗的年轻人自杀意念会有更大程度的减少(初级 与单独使用SAU相比，随着时间的推移，药物使用和抑郁症状(次要结果)， 以及改进的风险和保护因素。理论上派生的调解人将接受测试，以阐明 与变化相关的机制，以及性别、种族、性取向和基线的缓和效应 将检查服务连接。为了便于今后将干预措施传播到各机构 为服务叶，我们将严格评估可接受性、可行性、保真度和与交付 我们的干预方法采用混合方法。最终，这项研究的目标是提供 支持对使用YEA的物质进行自杀预防干预，以减少早产 死亡率、住院率和人力资本损失，可以很容易地被服务于叶诗文的机构采用。

Project Summary/Abstract While research on substance using youth experiencing homelessness (YEH) is increasing, there is a dearth of information regarding effective prevention interventions for these youth. This is of significant concern because studies indicate that 66% to 89% of YEH have a mental health disorder (Cauce et al., 2004) and 68% report at least one suicide attempt (Gewitz et al., 2020). In fact, suicide is the leading cause of death among YEH (Rotheram-Borus & Milburn, 2004; Yoder et al., 2010). Among those who have attempted suicide, an average of 6.2 attempts is reported, and lifetime suicidal ideation rates range from 14% to 66.5% (Yoder et al., 2010) with no clear evidence of effective interventions for YEH. This study uses general cognitive theory (Beck, 1967), complemented with concepts from two suicide specific theoretical models, to guide our intervention and conceptual change model. Our goal is to test strategies to extend delivery and uptake of a cognitive therapy intervention for YEH. Prior studies focus on service-connected youth, but research suggests that most street living YEH do not access services meant to assist them (Kelly & Caputo, 2007). We overcome prior sampling limitations through engaging service-disconnected youth in addition to service-connected youth through a local drop-in center. As such, three hundred substance using YEH with recent suicidal ideation or a recent suicide attempt will be randomly assigned to Cognitive Therapy for Suicide Prevention (CTSP) + Services as Usual (SAU) (N=150) or to SAU alone (N=150). CTSP has previously shown efficacy for YEH through a RCT pilot feasibility study (Slesnick et al., 2020; Wu et al., 2020). SAU includes outreach, advocacy and service linkage which are typical services offered by agencies serving those experiencing homelessness (Ober et al., 2012). Follow-up assessments will be conducted at 3, 6, 9 and 12-months post-baseline. It is hypothesized that youth receiving CTSP+SAU will show greater reductions in suicidal ideation (primary outcome), substance use and depressive symptoms (secondary outcomes) over time compared to SAU alone, as well as improved risk and protective factors. Theoretically-derived mediators will be tested to shed light on mechanisms associated with change, and the moderating effects of sex, race, sexual orientation and baseline service connection will be examined. In order to ease future dissemination of the intervention to agencies serving YEH, we will rigorously assess acceptability, feasibility, fidelity and cost associated with the delivery of our intervention approach using a mixed-methods approach. Ultimately, the goal of this research is to provide support for the use of a suicide prevention intervention for substance using YEH that reduces premature mortality, hospitalization, and loss of human capital and which can be easily adopted by agencies serving YEH.