Reducing suicide risk among aging caregivers of persons with AD/ADRD: Adapting, implementing, and evaluating Dialectical Behavior Therapy skills training interventions.

摘要 阿尔茨海默病和阿尔茨海默病患者的非正式照顾者(IC；非专业照顾者) 疾病相关性痴呆症(AD/ADRD)经历与照顾相关的痛苦，并且高出约650% 自杀意念率(SI；32.32%)与一般人群(4.3%)相比。辩证行为疗法 (DBT)是一种以证据为基础的自杀干预措施，涉及心理社会功能的多个领域。 标准DBT通常过于耗费资源(6个月至1年的每周个别会议和1.5-2.5年- 每周一小时的技能培训小组会议)，而不是为患有AD/ADRD和SI的人的IC量身定做，创建 SI治疗的一个重要障碍。我们将开发、实施和评估适应的DBT技能培训 针对AD/ADRD患者的ICs的独特经验和需求而定制的小组，以减少自杀 最迟的结果最有效。我们的具体目标是：(1)使DBT技能小组适应IC(具有以下条件的人员) AD/ADRD)认可直接或间接SI(直接陈述的SI与SI的间接指标)，以确保其适用于 直接和间接SI，并认为SI少报；(2)评估以下项目的可行性、可接受性和保真度 本样本中适应的DBT技能组；(3)评估适应的DBT技能组的初步有效性指标 DBT技能小组。对于目标1，一个专家小组和两个利益攸关方(加里森老龄研究所(GIA)工作人员； 患有AD/ADRD的人的IC)，将通知DBT技能培训适应患有AD/ADRD的人的IC AD/ADRD，并缩短到每周16次，每小时1小时的技能小组课程，为期4个月。对于目标2和目标3，我们将 在患有直接/间接SI的AD/ADRD患者的IC中实施适应的DBT技能培训小组 在筛查时，同时提供喘息，所有在GIA。我们将从IC和IC-Re-Re收集相关的人口数据- 移植了AD/ADRD患者的数据。超过18个时间点(基线，在每周DBT会议之后， 后续)，参与者将完成针对DBT保真度/可接受的SI(直接和 间接)，与自杀风险相关。我们还将录制DBT会话以监控保真度。我们将追踪粒子- PANT招聘、团队出席率、留存作为可行性指标。我们还将使用创新的方法 收集炎症生物标志物和心率变异性数据作为间接SI评估。最后，我们将 在干预后进行IC焦点小组，以获得更多定性可接受性和可行性数据。我们会 还要对GIA现场工作人员进行调查，以评估他们对GIA干预措施的可接受性和可行性。我们的 假设1)我们适应的DBT技能小组将是可行的、可接受的，并保持DBT的保真度， 和2)SI(直接和间接)、自杀危险因素和炎症将减少，心率变异性将 加大事后干预力度。我们的预期结果是对以下集成电路进行可扩展的DBT小组干预 ADRD患者、可行性和可接受性的迹象以及初步效果指标。这 工作将为AD/ADRD患者的IC提供一种拯救生命的自杀预防方法，为学生提供 具有多学科研究经验，并显著加强了我们的大学研究环境。

ABSTRACT Informal caregivers (ICs; non-professional caregivers) of persons with Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD) experience caregiving-related distress and have about 650% higher rates of suicide ideation (SI; 32.32%) compared to the general population (4.3%). Dialectical Behavior Therapy (DBT), an evidence-based intervention for suicide, addresses multiple areas of psychosocial functioning. Standard DBT is often too resource-intensive (6 months to 1 year of weekly individual sessions and 1.5-2.5- hour weekly skills training group sessions) and is not tailored to ICs of persons with AD/ADRD with SI, creating a significant barrier to SI treatment. We will develop, implement, and evaluate an adapted DBT skills training groups tailored to the unique experiences and needs of ICs of persons with AD/ADRD to reduce suicide-re- lated outcomes most effectively. Our specific aims are: (1) Adapt DBT skills groups for ICs (of persons with AD/ADRD) endorsing direct or indirect SI (directly stated SI vs. indirect indicators of SI) to ensure it applies to direct and indirect SI and considers SI underreporting; (2) Evaluate the feasibility, acceptability, and fidelity of the adapted DBT skills groups in this sample; (3) Assess preliminary effectiveness indicators of the adapted DBT skills groups. For Aim 1, a panel of experts and two stakeholders (Garrison Institute of Aging (GIA) staff; IC of a person with AD/ADRD), will inform the adaptation of DBT skills training to ICs of persons with AD/ADRD and shorten to 16 weekly, 1-hour skills groups sessions, over 4 months. For Aims 2 and 3, we will implement the adapted DBT skills training groups among ICs of persons with AD/ADRD with direct/indirect SI at screening while providing respite, all at GIA. We will collect relevant demographic data from ICs and IC-re- ported data about the person with AD/ADRD. Over 18 time points (baseline, following weekly DBT sessions, follow-up), participants will complete self-report assessments targeting DBT fidelity/acceptably, SI (direct and indirect), and suicide risk correlates. We will also record DBT session to monitor fidelity. We will track partici- pant recruitment, group attendance, retention as feasibility metrics. We will also use innovative methodology by collecting inflammation biomarkers and heart rate variability data as an indirect SI assessment. Lastly, we will conduct IC focus groups after the intervention for additional qualitative acceptability and feasibility data. We will also survey GIA site staff to evaluate their perceived acceptability and feasibility of the intervention at GIA. Our hypotheses are that 1) our adapted DBT skills group will be feasible, acceptable, and maintain DBT fidelity, and 2) SI (direct and indirect), suicide risk factors, and inflammation will decrease, and heart rate variability will increase post intervention. Our expected outcomes are to have a scalable DBT group intervention for ICs of persons with ADRD, indications of feasibility and acceptability, and preliminary effectiveness indicators. This work will provide a life-saving suicide prevention approach for ICs of persons with AD/ADRD, provide students with multidisciplinary research experiences, and significantly strengthen our university research environment.