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.

普通公众和学校工作人员对筛查调查普遍担心的是，询问青少年自杀想法和行为是否真的会引发随后的自杀意念和行为——人们普遍认为，询问自杀问题“将想法灌输到青少年的头脑中”。 没有直接的经验基础来支持或否认这种担忧。 目前的提案重点关注筛查计划的这种严重潜在风险，在大规模实施这种基于社区的干预措施之前必须解决这一风险，并将其纳入公共卫生自杀预防举措。将在两阶段筛选策略的背景下进行具有重复测量的随机实验设计。将采用生态有效的环境（高中），而不是实验室环境，以便将研究结果推广到自杀筛查项目进行的情况。 纽约州萨福克县和威彻斯特县的七所高中将进行两阶段筛选计划。 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）将接受第一阶段筛选调查，其中包括一组评估自杀意念和行为的问题；对照组（N=1,000）将接受第一阶段调查，但不包括自杀问题。 在第一阶段调查的开始和结束时将进行短暂情绪状态的测量，以评估心理困扰。在第一阶段筛选调查 2 天后进行的第二阶段调查将评估更持久的痛苦。调查的一个特别重点是筛选调查对高危学生的影响，例如抑郁或滥用药物的青少年或有自杀企图历史的学生。本研究的结果将减轻阻碍实施的恐惧这些筛查计划，或强调需要解决的严重问题。 这些信息将用于指导制定更安全、更有效的基于学校的自杀预防/干预计划。