Evaluating Iatrogenic Risk of Suicide Screening Program

评估自杀筛查计划的医源性风险

• 批准号: 6419979
• 负责人: MADELYN S GOULD
• 金额: $ 62.3万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-12-17 至 2004-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6419979
• 关键词: adolescence (12-20); behavior prediction; behavioral /social science research tag; clinical research; community mental health services; disease /disorder proneness /risk; emotions; health services research tag; health surveys; human subject; human therapy evaluation; iatrogenic disease; mass screening; mental disorder prevention; psychological stressor; public health; secondary schools; suicide; therapy adverse effect

A pervasive concern among the lay public and school personnel about screening surveys is whether asking a youngster about suicidal thoughts and behavior may actually trigger subsequent suicidal ideation and behavior - the common belief that asking about suicide "puts ideas into the heads" of youngsters. There is no direct empirical basis on which to support or repudiate this concern. The present proposal focuses on this serious potential risk of screening programs, which must be addressed before a large-scale implementation of this community-based intervention should be included in a public health suicide prevention initiative. A randomized experimental design with repeated measures will be conducted within the context of a two-stage screening strategy. An ecologically valid setting (high schools) will be employed, rather than a laboratory setting, to enable the generalization of the findings to the situations where the suicide screening programs take place. A two-stage screening program will be conducted in seven high schools in Suffolk and Westchester counties in New York State. Students within each high school will be randomized to either an experimental group or a control group. The experimental group (N=1,000) will receive a 1st stage screening survey with a set of questions assessing suicidal ideation and behavior; the control group (N=1,000) will receive the 1st stage survey without the set of suicide questions. A measure of transient mood states will be given at the beginning and end of the 1st stage survey to assess psychological distress. More persistent distress will be assessed during a 2nd stage survey, administered 2 days after the 1st stage screening survey. A particular focus of investigation will be the impact of the screening survey on high-risk students, such as depressed or substance abusing youngsters or those with a past history of suicide attempts The results of the present study will either allay fears that are impeding the implementation of these screening programs, or underscore a serious problem that needs to be addressed. This information will be used to guide the development of more safe and effective school-based suicide prevention/intervention programs.

外行公共和学校人员对筛查调查的普遍关注是，询问一个关于自杀思想和行为的询问是否可能会触发随后的自杀念头和行为 - 普遍的信念，即询问自杀“将思想”“将年轻人置于脑海中”。 没有直接的经验基础来支持或否定这种关注。 本提案的重点是这种严重的筛查计划的潜在风险，必须在大规模实施这种基于社区的干预措施之前解决，该计划应包括在公共卫生自杀计划中。将在两阶段筛选策略的背景下进行重复测量的随机实验设计。将采用具有生态有效的环境（高中），而不是实验室环境，以使调查结果对发生自杀筛查计划的情况进行概括。 纽约州的萨福克郡和威彻斯特县的七个中学将进行两阶段的筛查计划。 每所高中的学生将被随机分为实验组或对照组。 实验组（n = 1,000）将接受第一阶段筛查调查，并有一组评估自杀意念和行为的问题；对照组（n = 1,000）将接受第一阶段的调查，而无需自杀问题。 在第一阶段调查的开始和结束时，将对瞬态情绪状态进行衡量，以评估心理困扰。在第一阶段筛查调查后2天进行的第二阶段调查中，将评估更多持续的困扰。调查的一个特殊重点将是筛查调查对高风险学生的影响，例如抑郁症或滥用年轻人的抑郁症或有自杀史的人，本研究的结果会消除阻碍这些筛查计划实施的恐惧，或者强调需要解决的严重问题。 该信息将用于指导开发更安全有效的基于学校的自杀/干预计划。