Early Intervention for Suicide Risk among Immigrant Youth

项目摘要 背景自杀是美国15-24奥尔兹的第二大死亡原因， 缺乏以证据为基础的预防计划，明确解决自杀风险因素之前， 自杀企图的开始。第一代和第二代移民青年占美国人口的25% 18岁以下，有自杀意念和企图的特定风险因素。这包括家庭冲突 由于父母和子女之间的文化期望不同， 通信与此同时，以家庭为基础的预防性干预措施侧重于加强家庭 保护性因素有望降低日后的自杀风险。研究战略。本研究的重点 透过三个互相关连的方法，发展和测试以家庭为基础的预防自杀措施。 项目这些是：1）对现有的两个数据集进行纵向分析，以确定社会支持如何 资产（例如，家庭，同伴和社区支持的经验）缓冲自杀风险的青少年在高 自杀行为的风险，并研究这些关联如何因性别和种族/民族而异; 2） 利用干预绘图和定性数据来制定和完善新的预防性干预措施， 移民青年自杀风险的早期干预;以及3）首先对早期干预进行试点测试， 和第二代移民拉丁裔/a青少年筛选阳性自杀风险和他们的家庭。40 家庭将被随机分配到干预组或常规护理组。可行性、可接受性和对 将评估干预目标。培训计划。为了配合研究计划，阿尔瓦雷斯博士将 在以下三个领域开展培训：（1）与发展有关的方法， 评价针对低基本率行为的预防干预措施; 2）创新方法， 临床研究背景下的自杀风险评估; 3）预防方案的设计和测试 在医疗保健，学校和社区环境中提供，特别关注自杀预防。她 这项研究将在马萨诸塞州总医院的差异研究中心进行，该中心是哈佛医学院的一个分支。 学校附属的主要医疗中心提供了丰富的临床研究资源， 培训机会。导师制。该项目的指导小组提供了一系列互补的 与本提案的研究和培训目标相关的专门知识。阿尔瓦雷斯医生的主要导师阿莱格里亚医生 是健康差异和卫生服务研究方面的专家，在早期指导方面拥有丰富的经验。 职业调查员，包括K奖获得者。她的共同导师怀曼博士提供青少年自杀方面的专业知识 预防和预防研究，共同导师Shrout博士提供统计建模的专业知识， 纵向数据和临床试验结果分析。一个顾问团队提供额外的专业知识， 抑郁症和自杀行为的流行病学（罗伯茨博士），心理健康的适应性测试 评估（吉本斯博士），以家庭为基础的预防性干预设计和评估（潘廷博士），和临床 抑郁症和相关疾病的试验（阿尔珀特博士）。候选人阿尔瓦雷斯博士是一名早期职业研究员 接受过学校和儿童临床心理学培训，正在完成NIMH资助的健康博士后培训 差异和心理健康服务研究侧重于文化多样性人口。K23项目 将为她作为一名专门从事自杀预防的临床研究人员的职业生涯奠定基础， 特别侧重于满足移民青年需求的干预措施， 在保健和社区环境中提供预防干预。

PROJECT SUMMARY Background. Suicide is the second leading cause of death among 15-24 year olds in the United States, yet there is a dearth of evidence-based prevention programs that explicitly address suicide risk factors prior to the onset of suicide attempts. First and second generation immigrant youth comprise 25% of the U.S. population under 18 and experience specific risk factors for suicidal ideation and attempts. This includes family conflict exacerbated by differing cultural expectations between parents and children and disruptions to parent-child communication. At the same time, family-based preventive interventions focused on enhancing family protective factors show promise for reducing later suicide risk. Research Strategy. The present study focuses on developing and testing a family-based preventive intervention for suicide risk through three interrelated projects. These are: 1) Conducting longitudinal analyses of two existing datasets to identify how social support assets (e.g., experiences of family, peer, and community support) buffer suicide risk for adolescents at high risk of suicidal behavior, and examining how these associations may vary by gender and racial/ethnic group; 2) Utilizing intervention mapping and qualitative data to develop and refine a new preventive intervention, the Early Intervention for Suicide Risk among Immigrant Youth; and 3) Pilot testing the early intervention with first and second generation immigrant Latino/a adolescents screening positive for suicide risk and their families. 40 families will be randomized to the intervention or to usual care. Feasibility, acceptability, and impact on the intervention targets will be assessed. Training Plan. In coordination with the research plan, Dr. Alvarez will pursue training in the following three areas: 1) methodological approaches relevant to development and evaluation of preventive interventions targeting low base rate behaviors; 2) innovative approaches to assessment of suicide risk in clinical research contexts; and 3) design and testing of prevention programs delivered in healthcare, school, and community settings, with a particular focus on suicide prevention. Her research will be based at the Disparities Research Unit in Massachusetts General Hospital, a Harvard Medical School affiliated, major medical center providing access to an abundance of clinical research resources and training opportunities. Mentorship. The project’s mentorship team provides a range of complementary expertise relevant to the research and training aims of this proposal. Dr. Alvarez’s primary mentor, Dr. Alegria, is an expert in health disparities and health services research with extensive experience in mentoring early career investigators, including K awardees. Her co-mentor Dr. Wyman provides expertise in youth suicide prevention and prevention research, and co-mentor Dr. Shrout provides expertise in statistical modeling of longitudinal data and analysis of clinical trial outcomes. A team of advisors provides additional expertise in the epidemiology of depression and suicidal behaviors (Dr. Roberts), adaptive testing for mental health assessment (Dr. Gibbons), family-based preventive intervention design and evaluation (Dr. Pantin), and clinical trials for depression and related disorders (Dr. Alpert). Candidate. Dr. Alvarez is an early career researcher trained in school and child clinical psychology who is completing NIMH-funded postdoctoral training in health disparities and mental health services research focused on culturally diverse populations. This K23 project would provide the foundation to launch her career as a clinical researcher specializing in suicide prevention, with a particular focus on interventions addressing the needs of immigrant youth and on family-based preventive interventions delivered in healthcare and community settings.