Quantifying Real-world Effectiveness of Mental Health Interventions for Suicide Prevention in At-risk Adolescent and Transitional Age Youth

项目摘要和摘要-剑桥健康联盟 高危青少年早期筛查和治疗的快捷性 R34--量化心理健康干预在预防自杀方面的真实效果-- 高危青少年和过渡年龄青少年 为不同种族/民族和语言(REL)的不同人口确定有效的自杀预防战略 自杀风险高的青少年对公共卫生具有极大的重要性。10至24岁人士的自杀率 在过去十年中，几乎每个州和几乎每个种族/民族的人口都增加了50%以上 少数群体，特别是黑人青年自杀企图的增加。在这个项目中， 我们利用超过15,000名自杀高危青年患者的独特临床-社会背景数据集来 开展社区心理健康高维比较有效性研究(CER) 预防不同性别青少年自残思想和行为的干预措施 处于过渡期的年轻人。我们拥有一个庞大的临床、保险、刑事司法和个人仓库- 以及社区层面的健康数据的社会决定因素，以多维度匹配治疗和控制 并评估不同的社区治疗制度对自杀结局的影响。 在目标1中，我们建议使用大型回顾性临床研究进行创新的比较有效性研究- 社会背景数据集，以确定有效的自杀预防治疗，以及这些治疗方法在 Rel-多样化的群体。 在目标2中，我们确定了这一队列中当前的一个子样本，在此基础上进行了回顾分析 一种计算机化的适应性测试，分析当今自杀结果、精神病理学和社会测量 健康和护理质量的决定因素。这将允许评估长期治疗结果，以及 未观察到的变量如何会对比较有效性研究结果产生偏差。 这项研究为两项R01水平的研究奠定了基础：1)更大规模的CER治疗方案试验 多个机构；以及2)一项序贯多分配随机试验(SMART)，评估 系统性适应治疗对自杀结局的影响。该项目将有助于更好地 了解是否、如何、何时以及为谁更改持续时间、频率、类型或交付 在治疗过程中的关键步骤进行治疗，从而导致干预措施，从而降低 易受伤害的相关人群中的自杀行为。

PROJECT SUMMARY AND ABSTRACT – Cambridge Health Alliance ALACRITY for Early Screening and Treatment of High Risk Youth (eSToRY) R34 - Quantifying real-world effectiveness of mental health interventions for suicide prevention in at- risk adolescent and transitional age youth Identifying effective suicide prevention strategies for racial/ethnic and language (REL)-diverse populations of youth at high risk of suicide has enormous public health importance. Suicide rates for persons aged 10–24 have increased by more than 50% over the last decade in nearly every state and for nearly every racial/ethnic minority group, with particularly concerning increases in suicide attempts among Black youth. In this project, we utilize a unique clinical-sociocontextual dataset of over 15,000 youth patients at high risk for suicide to conduct high-dimensional comparative effectiveness research (CER) of community-based mental health interventions in the prevention of self-injurious thoughts and behaviors among REL-diverse adolescents and transitional age youth. We leverage an enormous warehouse of clinical, insurance, criminal justice, individual- and neighborhood-level social determinants of health data to multi-dimensionally match treatment and control groups and assess the impact of differing community-based treatment regimes on suicidal outcomes. In Aim 1, we propose innovative comparative effectiveness research using a large retrospective clinical- sociocontextual dataset to identify effective treatments for suicide prevention, and how these differ across REL-diverse groups. In Aim 2, we identify a sub-sample of this cohort in the present day, following up our retrospective analysis with a computerized adaptive test analyzing current day suicidal outcomes, psychopathology, and measures social determinants of health and quality of care. This will allow for assessment of long-run treatment outcomes, and how unobserved variables may bias comparative effectiveness research results. This study lays the groundwork for two R01-level studies: 1) a larger CER trial of treatment regimes across multiple institutions; and 2) a sequential multiple assignment randomized trial (SMART) that evaluates the impact of systematic adaptation of treatment on suicide outcomes. The project will contribute to a better understanding of whether, how, when, and for whom to alter the duration, frequency, type, or delivery of treatments at pivotal steps in the episode of treatment, leading to interventions that will reduce the risk of suicidality in vulnerable REL-diverse populations.