Parent-adolescent informant discrepancies: Predicting suicide risk and treatment outcomes

项目总结 自杀是美国青少年死亡的第二大原因。研究表明， 自杀念头通常出现在青春期早期，这些人大约有12次 他们比没有自杀倾向的同龄人更有可能在成年后表现出自杀行为，强调 青春期是进行干预的关键发展时期。然而，这些自杀死亡的诱因(即， 自杀想法和行为)仍然很难预测和治疗。经常进行全面评估 包括父母报告和青少年的自我报告，以确定需要干预的人，并 检查治疗反应。从历史上看，这些评估都是基于高度的 一致的家长-青少年报告，或将一个告密者的报告优先于另一个告密者。那里 在如何最好地解释和利用不一致的举报人报告方面，仍然存在严重的知识差距。 几十年的青年精神病理学研究表明，多信息者不一致的报告模式(DRP) 不是糟糕评估的同义词，但可能表明有临床意义的信息。在现在 研究中，我们借鉴了联合赞助商德洛斯雷耶斯的运营三合会模型，这是一套解释 汇聚和差异报告的功能，以检查跨两个上下文的多个信息者DRP。在追捕中 对于目标1，我们将通过从已完成的“评估”中提取数据来初步检查非治疗背景 一项以父母和青少年(n=96)关于自残想法的基线报告为特色的研究 和行为访谈-修订(R15MH113076；PI/主要赞助商Cha)。我们将测试基线是否 社区青少年自杀念头和行为的亲子关系预测 未来的自杀意念发生在3个月和6个月后。为了达到目标2，我们将研究一种治疗方法 通过从一项正在进行的随机对照试验(即“治疗研究”)中提取数据， 亲子双方(n=100)在哥伦比亚自杀严重程度评定量表上的治疗报告 (R01MH123556；MPI/共同赞助商日元)。我们将测试治疗前亲子-青少年DRP是否 住院青少年自杀念头和行为对其治疗后自杀意念的预测作用 行为，以及这些影响是否通过治疗分配得到缓解(增强的主动技能 积极干预与通常的强化治疗相比)。多项式回归与响应面 分析将用于探索亲子DRP的方向性和程度(目标1-2)。与 多信息者DRP在治疗和非治疗中预测青少年未来风险的意向 治疗环境下，这项工作的长期目标是最大化信息的预后价值，即 作为青年心理健康标准评估的一部分，很容易收集。

PROJECT SUMMARY Suicide is the 2nd leading cause of death among adolescents in the United States. Research suggests that the onset of suicidal ideation usually arises in early adolescence and these individuals are approximately 12 times more likely than their non-suicidal peers to exhibit suicidal behavior by middle adulthood, highlighting adolescence as a key developmental period for intervention. Yet, these precipitants of suicide death (i.e., suicidal thoughts and behaviors) remain difficult to predict and treat. Comprehensive assessments often include reports from parents and self-reports from adolescents to identify those in need of intervention and examine treatment responses. Historically, these assessments have been interpreted based on highly convergent parent-adolescent reports, or the prioritization of one informants' report over another. There remains a critical knowledge gap around how to best interpret and utilize inconsistent informant reports. Decades of research in youth psychopathology suggest multi-informant discrepant reporting patterns (DRPs) are not synonymous with poor assessment, but may indicate clinically meaningful information. In the present study, we draw from Co-Sponsor De Los Reyes' Operations Triad Model, a set of principles that elucidate the function of converging and discrepant reports, to examine multi-informant DRPs across two contexts. In pursuit of Aim 1, we will initially examine a non-treatment context by drawing data from a completed `Assessment Study' featuring baseline reports from parent-adolescent dyads (n=96 dyads) on the Self-Injurious Thoughts and Behaviors Interview-Revised (R15MH113076; PI/Primary Sponsor Cha). We will test whether baseline parent-adolescent DRPs about community-based adolescents' suicidal thoughts and behaviors predict their future suicidal ideation occurring 3- and 6-months later. In pursuit of Aim 2, we will then examine a treatment context by drawing data from an ongoing randomized controlled trial (i.e., `Treatment Study') featuring pre- treatment reports from parent-adolescent dyads (n=100 dyads) on the Columbia-Suicide Severity Rating Scale (R01MH123556; MPI/Co-Sponsor Yen). We will test whether pre-treatment parent-adolescent DRPs about inpatient adolescents' suicidal thoughts and behaviors predict their post-treatment suicidal ideation and behavior, and whether these effects are moderated by treatment assignment (active `Skills to Enhance Positivity' intervention vs. enhanced Treatment as Usual). Polynomial regression and response surface analyses will be used to probe the directionality and degree of parent-adolescent DRPs (Aims 1-2). With the intention of testing whether multi-informant DRPs predict adolescents' future risk across treatment and non- treatment settings, the long-term goal of this work is to maximize the prognostic value of information that is readily collected as a part of standard mental health evaluations for youth.