Development of mHealth-Supported Skills Training for Alcohol and Related Suicidality (mSTARS): Emotion Regulation Skills Training to Enhance Acute Psychiatric Care and Recovery

酒精滥用与自杀危机密切相关（即，急性自杀意念或企图）和死亡。 对自杀危机的标准治疗，包括对滥用酒精的人，是急性精神病治疗。 住院急性精神病住院治疗的重点是稳定和危机解决之前，迅速 将高危患者送回压力环境，并转介到门诊治疗。门诊- 以情绪调节训练为重点的干预措施已被证明可以同时减少酒精 滥用和自杀行为。然而，只有不到50%的精神病住院患者坚持门诊治疗。 治疗，这造成了一个危险的照顾差距;自杀的风险是最高的最近出院 滥用酒精的病人。这个指导以患者为导向的研究职业发展奖（K23） 涉及开发一种新的预防性干预措施，以（1）加强对高危精神病患者的标准护理， 滥用酒精的住院患者，以及（2）为持续康复创造机会，降低 出院后出现自杀危机。这项干预措施名为"移动健康支持技能"， 酒精和相关自杀行为培训（mSTARS），结合情绪调节技能培训 在急性环境中使用mHealth应用程序，旨在鼓励在治疗期间使用这些技能。 出院后的危险期K23的研究计划分为两个阶段：开发（第一阶段：AIMS 1和2）以及mSTARS的可行性和可接受性评价（第2阶段：AIM 3）。通知mHealth应用程序 为配合发展，我们会进行一项为期六星期的精神科自杀个案生态瞬时评估研究， 滥用酒精的住院患者（N = 35），以阐明饮酒的时变预测因素， 自杀意念，并研究特定的情绪调节缺陷的作用。分析将有助于 对应用程序进行调整，以真实的时间为情绪调节技能提供基于经验的建议 (AIM 1）。mSTARS，包括住院技能培训组件和mHealth应用程序，将迭代完善 在自杀精神病住院患者的两个连续队列（每个队列n = 5）中，每例患者驱动的修改 滥用酒精（AIM 2）。mSTARS的最后版本，同时纳入AIM 1的调查结果，将 在AIM 3中评价了一项比较mSTARS的三组可行性/可接受性随机对照试验（n = 15） 住院技能培训（n = 10）和常规治疗（TAU）（n = 10）。K23的研究计划是 与PI的培训目标密切相关，这是为了获得（1）先进的纵向建模经验， EMA数据，（2）mHealth支持的治疗开发，以及（3）临床试验设计和管理。超过 在5年K23奖励期内，这些培训目标将促进PI的总体职业目标， 独立的临床研究者。从K23开始，PI研究计划的更广泛目标是 制定综合的、可扩展的、具有成本效益的移动健康支持的干预措施，以治疗并发酒精 滥用和自杀行为，降低这一服务不足人群的风险。

Alcohol misuse is strongly associated with suicide crises (i.e., acute suicidal ideation or attempts) and death. The standard care for a suicide crisis, including for persons who misuse alcohol, is acute psychiatric hospitalization. Acute psychiatric hospitalization focuses on stabilization and crisis resolution prior to quickly discharging at-risk patients back into their stressful environments with a referral for outpatient care. Outpatient- based interventions focused on emotion regulation training have been shown to simultaneously reduce alcohol misuse and suicidal behavior. Yet, less than 50% of psychiatric inpatients follow through with outpatient treatment, which creates a dangerous gap in care; risk for suicide is the highest among recently discharging patients who misuse alcohol. This Mentored Patient-Oriented Research Career Development Award (K23) involves the development of a novel adjunctive intervention to (1) enhance standard care for at-risk psychiatric inpatients who misuse alcohol, and (2) create an opportunity for sustained recovery and reduced risk for a subsequent suicide crisis during the post-discharge period. This intervention, entitled mHealth-supported Skills Training for Alcohol and Related Suicidality (mSTARS), combines emotion regulation skills training implemented in the acute setting with a mHealth app designed to encourage utilization of these skills during the risky post-discharge period. The research plan for this K23 has two phases: development (Phase 1: AIMS 1 and 2) and evaluation of feasibility and acceptability of mSTARS (Phase 2: AIM 3). To inform mHealth app development, we will conduct a 6-week ecological momentary assessment (EMA) study on suicidal psychiatric inpatients who misuse alcohol (N = 35) to elucidate time-varying predictors for alcohol consumption and suicidal ideation, and examine the role of specific emotion regulation deficits. Analyses will facilitate adjustments to the app to make empirically-based recommendations for emotion regulation skills in real time (AIM 1). mSTARS, including the inpatient skills training component and mHealth app, will be iteratively refined per patient-driven modifications over two successive cohorts (n = 5 in each) of suicidal psychiatric inpatients who misuse alcohol (AIM 2). The finalized version of mSTARS, while incorporating AIM 1 findings, will be evaluated in AIM 3 in a three-arm feasibility/acceptability randomized control trial comparing mSTARS (n = 15) to inpatient skills training (n = 10) and treatment as usual (TAU) only (n = 10). The research plan for this K23 is closely tied to the PI’s training goals, which are to gain experience with (1) advanced longitudinal modeling of EMA data, (2) mHealth-supported treatment development, and (3) clinical trials design and management. Over the 5-year K23 award period, these training goals will facilitate the PI’s overarching career goal of becoming an independent clinical researcher. Beginning with this K23, the broader aim of the PI’s research program is to develop integrated, scalable, and cost-effective mHealth-supported interventions to treat concurrent alcohol misuse and suicidal behavior across treatment settings, reducing risk for this underserved population.