Developing a Digital Intervention for Adolescent Nonsuicidal Self-injury

项目摘要/摘要 据估计，全世界17%的青少年受到非自杀性自残(NSSI)的影响。较早发病于 青春期与更严重的NSSI轨迹、自杀计划和较差的生活质量有关。尽管 NSSI的早期干预是至关重要的，大多数患有NSSI的青少年不寻求专业帮助，许多人这样做 不亲自向任何人透露他们的行为，限制获得支持的途径，并阻止 治疗。虽然一些心理干预措施在减少青少年NSSI方面是有效的， 结构性障碍(例如，时间、成本)、态度障碍(例如，耻辱、心理健康素养)和流行率 不公开的情况限制了它们的可及性和覆盖面。数字心理健康干预(DMHI)呈现出 有机会接触到这一高危和未接受治疗的人群，并增加他们获得 循证心理学策略。事实上，青少年报告对数字干预的接受度和 参与NSSI在线寻求帮助的比率很高。然而，到目前为止，还没有公开可用的DMHIS 旨在支持这一青少年群体。在与美国精神健康协会(MHA)的合作下， 全国最大的精神健康倡导组织，拟议的K01申请将通过以下方式解决这一差距 设计和评估符合青少年(14-17岁)独特需求和偏好的DMHI 从事NSSI的人。这个项目将利用通过MHA的在线信息搜索的时刻 网站，提供集中于获取和实践循证技能的低强度DMHI 加强自律和提供求助信息，最终减少NSSI频率和 鼓励未来的治疗参与。与MHA合作交付DMHI提供了明确的 传播途径和接触到不同的未接受治疗的青少年群体。要设计 DMHI，我将采用以用户为中心的设计活动，让关键利益相关者参与研究和设计 确保青少年的需要和偏好在最终的DMHI中得到反映的进程。我也会让MHA 各利益攸关方通过其网站参与制定战略执行和传播计划。我 然后将对80名青少年(14-17岁)进行DMHI的随机对照试验(RCT) 按1：1随机抽样，接受DMHI(n=40)或积极心理教育对照(n=40)治疗 持续时间为8周。这个K01将是我实现职业目标的关键的第一步， 成为数字心理健康领域领先的独立研究人员。我的四个培训目标旨在 通过扩展我在以下方面的专业知识来支持这一总体目标：1)UCD和包括可用性在内的总结性方法 测试DMHIS并支持2)进行临床试验、3)可扩展的专业知识的进一步发展 实施方法，以及4)青少年NSSI的治疗模式。实现这些目标 培训目标和拟议的研究项目将提供发展 R01全动力混合动力实施-有效性试验，测试DMHI的效力。

PROJECT SUMMARY/ABSTRACT Nonsuicidal self-injury (NSSI) affects an estimated 17% of adolescents worldwide. Earlier onset in adolescence is linked to more severe trajectories of NSSI, suicide plans, and poorer quality of life. Though early intervention for NSSI is critical, most adolescents with NSSI do not seek professional help, and many do not self-disclose their behaviors to anyone in person, limiting access to support and preventing pathways to treatment. While several psychological interventions have been effective in reducing adolescent NSSI, structural barriers (e.g., time, cost), attitudinal barriers (e.g., stigma, mental health literacy), and the prevalence of non-disclosure constrain their accessibility and reach. Digital mental health interventions (DMHIs) present an opportunity to reach this high-risk and non-treatment-engaged population and increase their access to evidence-based psychological strategies. Indeed, adolescents report receptivity to digital interventions and engage in NSSI help-seeking online at high rates. However, to date there are no publicly available DMHIs designed to support this adolescent population. In collaboration with Mental Health America (MHA), the nation's largest mental health advocacy organization, the proposed K01 application will address this gap by designing and evaluating a DMHI attuned to the unique needs and preferences of adolescents (14-17 years) who engage in NSSI. This project will leverage a moment of online information-seeking through MHA's website, to deliver a low-intensity DMHI focused on acquisition and practice of evidence-based skills to improve self-regulation and deliver help-seeking information, to ultimately reduce NSSI frequency and encourage future treatment engagement. Partnering with MHA to deliver the DMHI provides a clear dissemination pathway and access to a diverse group of adolescents who are not in treatment. To design the DMHI, I will employ user-centered design activities, which involve key stakeholders in the research and design process to ensure adolescents' needs and preferences are reflected in the final DMHI. I will also engage MHA stakeholders in the development of a strategic implementation and dissemination plan through their website. I will then pilot a randomized controlled trial (RCT) of the DMHI with 80 adolescents (14-17 years of age) randomized on a 1:1 basis to receive the DMHI (n=40) or an active psychoeducational control (n=40) for the duration of 8 weeks. This K01 will be a critical first step in positioning me to achieve my career goal and become a leading independent researcher in digital mental health. My four training aims are designed to support this overarching goal by extending my expertise in: 1) UCD and summative methods including usability testing for DMHIs and support further development of expertise in 2) the conduct of clinical trials, 3) scalable implementation methodologies, and 4) treatment models for adolescent NSSI. Accomplishment of these training goals and the proposed research project will provide the skills necessary for the development of an R01 of a fully powered hybrid implementation-effectiveness trial testing the efficacy of the DMHI.