Collaborative Hub to Reduce the Burden of Suicide among Urban American Indian and Alaska Native Youth

减轻城市美洲印第安人和阿拉斯加原住民青年自杀负担的合作中心

基本信息

批准号：
10186825
负责人：
DEDRA S BUCHWALD
金额：
$ 106.81万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-08-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10186825
关键词：
Address Adoption Affect Age Alaska Alaska Native American Indians Car Phone Caring Cause of Death Cessation of life Cities Communities Country Daughter Depressed mood Emotional Ensure Environment Event Evidence based practice Face Family Feeling suicidal Frequencies Goals Health Healthcare Healthcare Systems Home Hospitalization Husband Individual Institution Intervention Interview Left Life Link Mental Depression Mental disorders Modeling Native-Born Organizational Change Outcome Participant Patient Care Patients Physicians Policies Population Pregnancy in Adolescence Prevention Research Preventive Primary Health Care Process Provider Quality of life Randomized Randomized Controlled Trials Reporting Research Reservations Resources Risk Risk Factors Rural Site Substance abuse problem Suicide Suicide attempt Suicide prevention Technology Text Messaging Time Translating Tribes Work Youth arm base behavioral health care providers compare effectiveness completed suicide control trial cost economic evaluation effectiveness trial experience gang health care service organization health disparity health organization high risk innovation medical schools native youth patient oriented primary care setting reducing suicide reservation-based resilience response screening screening, brief intervention, referral, and treatment social statistics stem suicidal risk suicide rate treatment program tribal leader urban Native American urban area young adult

项目摘要

OVERALL PROJECT SUMMARY Suicide is the second leading cause of death for American Indian and Alaska Natives (AI/AN) ages 10-34, and is up to 6 times higher than for their White counterparts. Native youth also suffer a disproportionate burden of suicide risk factors, including mental health disorders, traumatic life events, and substance abuse. These findings derive largely from research in rural, reservation settings. Yet we know the “invisible tribe” in our cities faces enormous challenges stemming from lack of connection with traditional family and cultural environments. These challenges contribute to the notably greater risk of urban AI/AN youth and young adults (YYAs) compared to their non-AI/AN counterparts for attempted suicide (21% vs. 7%), as well as for depression, substance abuse, gang activity, teen pregnancy, and abuse. Yet calls for thoughtful, pragmatic research to inform suicide prevention among urban AI/AN YYAs have not been answered until now. Our response to RFA-MH-17-350, which seeks to establish collaborative hubs to reduce the burden of suicide among AI/AN YYAs, promises to redress the imbalance between urban and rural emphases in suicide prevention research. The central study, “Suicide Prevention for Urban Native Kids and Youth (SPUNKY),” builds on Screening, Brief Intervention and Referral to Treatment (SBIRT) carried out through primary care setting, to detect and manage suicide risk. This approach is multilevel, targeting both the healthcare system and the individual, and links screening to existing mobile phone technologies shown to promote resilience and to tap the protective benefits of social connectedness. This Collaborative Hub will: 1) evaluate existing SBIRT programs to identify and address factors that affect implementation and prevention of suicide among AI/AN YYA patients served by the Seattle Indian Health Board and First Nations Community Healthsource, the country's largest urban Indian health organizations; 2) conduct a randomized control trial that compares the effectiveness of enhancing these SBIRT programs by sending caring text messages to reduce suicidal ideation, attempts, and hospitalizations, and to increase engagement, social connectedness, and resilience, and 3) perform a systematic economic evaluation of SBIRT and its enhancements to determine their relative effects on the use of healthcare resources and quality of life. Our long-term goal is to disseminate and translate the lessons learned into practical policy, organizational changes, and preventive innovations that optimize patient- centered health outcomes and ultimately reduce or eliminate the dramatic and tragic suicide- related health disparities among urban AI/AN YYAs.

项目总体概要自杀是美洲印第安人和阿拉斯加原住民的第二大死因 (AI/AN) 年龄在 10-34 岁之间，比白人邻居高出 6 倍。还承受着不成比例的自杀风险因素负担，包括精神健康障碍，这些发现主要来自对农村地区的研究。然而我们知道，我们城市中的“隐形部落”面临着巨大的挑战。源于与传统家庭和文化环境缺乏联系。挑战导致城市 AI/AN 青年和年轻人 (YYA) 面临更大的风险与非 AI/AN 角色相比，他们尝试自杀（21% 对 7%），以及抑郁症、药物滥用、帮派活动、青少年怀孕和虐待仍然需要深思熟虑。为城市 AI/AN YYA 中的自杀预防提供信息的务实研究尚未开展直到现在才回答。我们对 RFA-MH-17-350 的回应，旨在建立协作中心以减少 AI/AN YYA 的自杀负担，有望纠正城市和青年之间的不平衡自杀预防研究的重点是农村。中央研究“城市的自杀预防”。本土儿童和青少年 (SPUNKY)，”以筛查、简短干预和转介为基础通过初级保健机构进行治疗 (SBIRT)，以检测和管理自杀风险。这种方法是多层次的，既针对医疗保健系统又针对个人，并且链接对现有移动电话技术进行筛选可提高复原力并利用社会联系的保护性好处。该协作中心将：1) 评估现有的 SBIRT 计划以识别和解决因素影响 AI/AN YYA 患者自杀的实施和预防西雅图印第安人健康委员会和美国最大的原住民社区健康资源印度城市卫生组织；2) 进行一项随机对照试验，比较通过发送关怀短信来增强这些 SBIRT 计划的有效性，以减少自杀意念、自杀企图和住院治疗，并增加参与度、社交能力连通性和弹性，以及 3) 对 SBIRT 进行系统的经济评估其增强功能以确定其对医疗资源使用的相对影响，以及我们的长期目标是传播经验教训并将其转化为生活质量。切实可行的政策、组织变革和预防性创新，以优化患者以健康结果为中心，最终减少或消除戏剧性和悲惨的自杀事件城市 AI/AN YYA 之间的相关健康差异。