Experiences and Outcomes of Suicidal Individuals with and without Autism in Emergency Departments Nationwide

全国急诊科有或没有自闭症的自杀者的经历和结果

• 批准号: 10487447
• 负责人: Shari Jager-Hyman
• 金额: $ 20.14万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-10 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10487447
• 关键词: Accident and Emergency department; Accounting; Ambulatory Care; American Hospital Association; Area; Caring; Cessation of life; Communities; County; Data Analyses; Data Set; Databases; Diagnosis; Emergency Care; Emergency Department Physician; Emergency Department-based Intervention; Emergency Situation; Emergency department visit; Environment; Event; Evidence based practice; Family member; Feeling suicidal; Funding; Future; General Population; Goals; Health Personnel; Hospitals; Individual; Inpatients; Intervention; Interview; Knowledge; Link; Medicaid; Mental Health; Mental Health Services; Methods; National Institute of Mental Health; Outcome; Outpatients; Patients; Persons; Policy Maker; Population; Premature Mortality; Prevention; Public Health; Recording of previous events; Records; Recurrence; Research; Resources; Risk; Self-Injurious Behavior; Services; Structure; Suicide; Suicide attempt; Suicide prevention; Surveys; Testing; Time; Training; United States Substance Abuse and Mental Health Services Administration; autism spectrum disorder; base; cohort; effectiveness study; experience; falls; follow-up; health service use; high risk population; hospital services; implementation strategy; improved; indexing; individuals with autism spectrum disorder; longitudinal design; outpatient programs; premature; prevent; service utilization; suicidal; suicidal behavior; suicidal individual; suicidal morbidity; suicidal risk; suicide rate

PROJECT SUMMARY/ABSTRACT Over half a million people in the U.S. present annually to Emergency Departments (EDs) for suicidal ideation (SI) and/or suicidal behavior (SB). After leaving the ED, their short-term risk of repeated self-harm and death by suicide are exceptionally high. Individuals with autism spectrum disorder (ASD) are disproportionally represented among those seen in the ED for suicide-related emergencies. Individuals with ASD are up to nine times more likely to experience SI and up to five times more likely to attempt suicide than the general population. Despite their increased risk for suicide and high rates of suicide-related ED visits, little is known about the experiences or outcomes of suicidal individuals with ASD seeking emergency care. The proposed mixed methods study will contribute to long-term efforts to reduce deaths by suicide by informing the adaptation and implementation of evidence-based practices for suicide prevention for individuals with ASD. The study objectives are: (a) to use a retrospective, longitudinal design to compare the experiences and outcomes of individuals with and without ASD who sought care for SI or SB in EDs nationwide; and (b) to interview key stakeholders about ways to improve ED-based suicide prevention practices and increase post-ED mental health treatment engagement for individuals with ASD. Claims records from over 100 million publicly- and privately-insured individuals will be used to ascertain and follow a diverse national cohort of patients with a suicide-related ED visit. Hospital- and county-level information will be drawn from the American Hospital Association Annual Survey Database, SAMHSA National Survey of Mental Health Treatment Facilities, and Area Resource File. Outcome variables include ED discharge disposition, outpatient mental health service utilization, SI or SB recurrence, and death by suicide (from the National Death Index). Semi-structured interviews with individuals with ASD and suicide-related ED visits, their family members, and ED physicians will elaborate upon the quantitative findings and inform potential targets for future ED-based intervention and implementation strategies. Results will help policy makers and healthcare workers across the U.S. to better understand critical points of prevention and intervention for suicidal individuals with ASD. This project is well- aligned with the Interagency Autism Coordinating Committee's objective to reduce disabling co-occurring mental health conditions and premature mortality in people with ASD, and NIMH's Strategic Objective 4 focused on strengthening the public health impact of NIMH-funded research.

项目摘要/摘要 在美国，每年有超过一百万的人到急诊部门（EDS）进行自杀念头 （SI）和/或自杀行为（SB）。离开ED后，他们的短期自我伤害和死亡的风险 自杀异常高。自闭症谱系障碍（ASD）的人不成比例 在ED中因自杀相关的紧急情况而言。 ASD的人最多九个 经历SI的可能性高，自杀的可能性比一般人群高五倍。 尽管他们自杀的风险增加和与自杀相关的ED访问率高，但对此知之甚少 ASD寻求紧急护理的自杀人的经验或结果。提议的混合 方法研究将有助于长期努力通过告知适应和 针对ASD患者实施基于证据的实践，以预防自杀。研究 目标是：（a）使用回顾性的纵向设计来比较 在全国范围内为SI或SB寻求护理的个人； （b）面试密钥 利益相关者关于改善基于ED基于ED的自杀预防实践的方法并增加了邮政的精神 ASD患者的健康治疗参与。索赔来自超过1亿多个公开和 私人保险人将被用来确定并遵循各种各样的国家群体 与自杀有关的ED参观。医院和县级信息将从美国医院获取 协会年度调查数据库，SAMHSA全国心理健康治疗设施调查， 区域资源文件。结果变量包括ED出院处置，门诊精神卫生服务 利用，SI或SB复发以及自杀死亡（来自国家死亡指数）。半结构 与ASD和自杀相关的ED访问，其家人以及ED医生的个人的访谈 将详细说明定量发现，并为未来基于ED的干预和 实施策略。结果将帮助美国各地的政策制定者和医疗保健工人改善 了解ASD自杀个体的预防和干预的关键点。这个项目很好 与机构间自闭症协调委员会的目标保持一致 心理健康状况和ASD患者的过早死亡以及NIMH的战略目标4集中 加强了NIMH资助研究的公共卫生影响。