Effectiveness and Implementation of a Peer Mentorship Intervention (PREVAIL) to Reduce Suicide Attempts Among High-Risk Adults

项目摘要 自杀是导致死亡的主要原因，在美国， 每年都给社会和公共卫生造成重大负担。被确定为自杀高风险的人是 经常住院接受心理健康治疗;然而，很少有干预措施可以减少 在出院后的高危期内自杀或企图自杀。同伴支持是一种新奇的 干预方法来解决两个实证支持的自杀风险因素， 和绝望，在高风险时期。PREVAIL是一种自杀预防干预措施， 研究将由同行支持专家、具有心理健康生活经验的个人提供 这些人已经实现了稳定的恢复，并接受了支持其他处于危险中的人的培训。PREVAIL包括3个 几个月的一对一会议，其中同侪支持专家分享他们的经验有关自杀， 参与半结构化的讨论，以提高受助人的希望和幸福感。 PREVAIL R 01有效性实施试验的资助是为了确定PREVAIL是否是 有效减少自杀企图和自杀意念，无论是改善绝望， 积极性解释自杀相关结果的改善，并确定障碍和促进因素， 卫生系统实施PREVAIL。该试验成功地满足了招募要求 里程碑，直到2020年3月，两个参与住院单位的面对面招募因 应对COVID-19大流行。在随后的一年中，新的议定书得到实施， 远程招募患者，并最终返回到现场招募;然而， 每个地点的招募率和招募率继续低于大流行病之前。轰击下 COVID-19，该研究将无法达到其最初招募490名参与者的目标， 剩余预算和时间轴。招聘不足的问题如果得不到解决，将对联合国人权事务高级专员办事处的权力产生不利影响。 研究旨在检测自杀未遂的主要结局的差异。 为应对COVID-19的影响，我们建议增加一个招聘网站，以实现原有的 PREVAIL试验的目标入组，并获得足够的把握度来确定同行的有效性 专家干预以减少自杀企图。新增的研究中心将是一个拥有48张床位的住院部， 选择亨利福特医疗保健系统，部分原因是这项研究已经得到了机构 审查委员会对当前亨利福特招聘网站的批准。通过实现我们的完整研究样本，我们还 建议在可接受性措施方面比较远程与亲自实施干预措施， 自杀意念由于COVID-19大流行，PREVAIL的干预措施从主要的面对面转变为 主要是远程（电话或视频）传输，效果不清楚。这些分析将提供重要的指导 卫生系统实施PREVAIL和其他类似的同伴支助干预措施。

PROJECT ABSTRACT Suicide is a leading cause of death, and the approximately 1 million suicide attempts that occur in the US each year represent a major societal and public health burden. Individuals identified as high risk for suicide are often admitted for inpatient mental health treatment; however, there are few interventions known to reduce suicides or suicide attempts during the high-risk period after hospital discharge. Peer support is a novel intervention approach to address two empirically supported risk factors for suicide, thwarted belongingness and hopelessness, during high-risk periods. PREVAIL is a suicide prevention intervention developed in a prior study to be delivered by peer support specialists, individuals with a lived experience of mental health challenges who have achieved stable recovery and are trained to support others at risk. PREVAIL consists of 3 months of one-to-one sessions in which peer support specialists share their experiences related to suicide and engage in semi-structured discussions to improve hope and belongingness among recipients. The PREVAIL R01 effectiveness-implementation trial was funded to determine whether PREVAIL is effective at reducing suicide attempts and suicidal ideation, whether improvement in hopelessness and belongingness explain improvements in suicide-related outcomes, and to identify barriers and facilitators to implementation of PREVAIL by health systems. The trial had been successfully meeting its recruitment milestones until March 2020 when in-person recruitment at both participating inpatient units was stopped due to the COVID-19 pandemic. Over the course of the subsequent year new protocols were put into place to recruit patients remotely and eventually return to in-person recruitment; however, the number of admissions at each site and the rate of recruitment continues to be lower than prior to the pandemic. Due to the impact of COVID-19, the study will not be able to reach its original recruitment goal of 490 enrolled participants under the remaining budget and timeline. The recruitment shortfall, if not addressed, will adversely limit the power of the study to detect a difference with respect to the primary outcome of suicide attempts. To address the impact of COVID-19, we propose to add an additional recruitment site to achieve the original target enrollment of the PREVAIL trial and achieve adequate power to determine the effectiveness the peer specialist intervention for reducing suicide attempts. The additional site will be a 48-bed inpatient unit within the Henry Ford healthcare system, which was chosen in part because the study has already received institutional review board approval for the current Henry Ford recruitment site. By achieving our full study sample, we also propose to compare remote vs. in-person implementation of the intervention on measures of acceptability and suicidal ideation. Due to the COVID-19 pandemic, the PREVAIL intervention shifted from primarily in-person to primarily remote (phone or video) delivery with unclear effects. These analyses will provide important guidance for health system implementation of PREVAIL and other similar peer support interventions.