Social Media Signals for reducing Perinatal Death by Suicide

摘要。自杀是美国年轻人死亡的第二大原因。 虽然大多数死于自杀的患者最近都与他们的医疗保健提供者有过接触，但医疗保健提供者的死亡率仍然很高。 输送系统的装备不足以解决这一可预防的问题。未检测到自杀风险，或 在大多数情况下，特别是在为低收入和种族群体服务的医疗机构， 种族多样的人口。在这项R34研究中，我们采用了由 研究基于自杀风险信号的生态瞬时评估（EMA）如何能够 在初级卫生保健中用于风险检测、评估、共同决策和长期 监视需要患者和提供者合作伙伴的输入来设计一个对这种护理有用的系统。 人口EMA系统显示出作为自杀风险指标的前景，并成为增强现有自杀风险的一种手段。 初级保健环境中的资源。然而，关于如何在上下文中应用这些方法， 也不清楚患者在多大程度上同意使用EMA进行风险预测， 监测.通过HCD的原则，我们建议为EMA衍生物创建一个临床可行的途径。 自杀风险的信号是可以接受的年轻成年患者和他们的医疗保健提供者。我们计划 为解决这一问题实现两个具体目标：（目标1）共同设计一个自杀风险监测系统， 增强瞬时个人生态风险评估（AMPERE），与患者和医疗保健 供应商通过HCD和（目标2）对原型的可接受性和可用性进行试点研究 AMPERE自杀风险检测和响应系统以及患者结局和我们假定的 患者和提供者自我效能和治疗联盟的机制。我们在这项研究中的目标是共同设计 EMA从创新的循证自杀风险检测策略到可接受的 和可用的临床工具，有可能遵循其他有效的风险检测策略。

ABSTRACT. Death by suicide is the 2nd leading cause of death among young adults in the United States. While most patients who die by suicide have had recent contact with their health care providers, the medical delivery system is poorly equipped to address this preventable issue. Risk of suicide is not detected or addressed in the majority of cases, particularly in health care settings serving low income and racially and ethnically diverse populations. In this R34 study we utilize human centered design (HCD) supported by the Center Methods Core to study how Ecological Momentary Assessment (EMA) based signals of suicide risk can be utilized in primary health care for Risk Detection, Assessment, Shared Decision-Making and Long-Term Surveillance. Patient and provider partner input is needed to design a system that has utility to the care of this population. EMA systems show promise as indicators of suicide risk and a means of enhancing existing resources in the primary care setting. However, little is known about how to apply these methods in the context of clinical care, nor is it apparent to what extent patients would agree to use EMA for risk prediction and monitoring. Through principles of HCD we propose to create a clinically actionable pathway for EMA derived signals of suicide risk that is acceptable to both young adult patients and their health care providers. We plan to carry out two specific aims to address this issue: (Aim 1) co-design a suicide risk monitoring system, Augmented Momentary Personal Ecological Risk Evaluation (AMPERE), with patients and health care providers through HCD and (Aim 2) conduct a pilot study of acceptability and usability of the prototype AMPERE suicide risk detection and response system as well as patient outcomes and our putative mechanisms of patient and provider self-efficacy and therapeutic alliance. Our goal in this study is to co-design a critical pathway for EMA from an innovative evidence-based suicide risk detection strategy to an acceptable and usable clinical tool that has potential for other effective risk detection strategies to follow.