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

• 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
• 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

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.

总体项目摘要 自杀是美洲印第安人和阿拉斯加土著人的第二大死亡原因 （AI/AN）10-34岁，比白色对应物高6倍。土著青年 还遭受了自杀危险因素的不成比例燃烧，包括心理健康障碍， 创伤性生活事件和滥用药物。这些发现主要来自农村的研究 预订设置。然而，我们知道我们城市中的“无形部落”面临巨大的挑战 由于缺乏与传统家庭和文化环境的联系。这些 挑战导致城市AI/年轻人和年轻人的风险更大（YYAS） 与他们的非AI/A A A A A A同行相比（21％比7％），以及 抑郁，滥用药物，帮派活动，青少年怀孕和虐待。但是需要思考， 务实的研究以告知城市AI/AN YYA中的自杀性预防措施 回答到现在。 我们对RFA-MH-17-350的反应，该RFA-MH-17-350试图建立协作枢纽以减少 AI/AN YYAS中的自杀负担有望纠正城市与城市之间的失衡 自杀预防研究的农村重点。中央研究：“预防城市自杀 基于筛查，简短的干预和转介的儿童和青年（脾气暴躁） 通过初级保健环境进行的治疗（SBIRT），以检测和管理自杀风险。 这种方法是多层次的，针对医疗系统和个人，并链接 对现有的手机技术进行筛选，以促进弹性并利用 社会联系的保护益处。 该协作中心将：1）评估现有的SBIRT程序以识别和解决因素 影响AI/A/A/A的YAYA患者的实施和预防自杀 西雅图印度卫生委员会和原住民社区卫生库，该国最大的 城市印度卫生组织； 2）进行随机对照试验，以比较 通过发送有爱心的短信来减少这些SBIRT程序的有效性 自杀的想法，尝试和住院以及增加参与，社会 连接性和弹性，以及3）对SBIRT进行系统的经济评估和 它的增强能够确定其对医疗资源使用的相对影响和 生活质量。我们的长期目标是传播并将所学的教训转化为 实用政策，组织的变化和预防性创新，以优化患者 以健康结果为中心，最终减少或消除了戏剧性和悲惨的自杀 城市AI/AN YYAS之间的相关健康差异。