Intensive Outpatient Protocol for High Risk Suicidal Teens

高危自杀青少年的强化门诊方案

基本信息

批准号：
8545221
负责人：
CHRISTIANNE L. ESPOSITO-SMYTHERS
金额：
$ 70.15万
依托单位：
BROWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-14 至 2016-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8545221
关键词：
Accident and Emergency department Address Admission activity Adolescent Affect Affective Aggressive behavior Alcohol consumption Alcohol or Other Drugs use Alcohols Anger Cognitive Therapy Cost Savings Data Day Care Depressed mood Depression and Suicide Diagnosis Emergency Care Emergency Situation Evaluation Event Family Family psychotherapy Feeling suicidal Goals Group Therapy Healthcare Systems Healthy People 2020 Hospitalization Hospitals Impulsivity Individual Inpatients Intervention Literature Maintenance Marijuana Smoking Mediating Mediator of activation protein Modeling Mood Disorders National Institute of Mental Health Outcome Outpatients Parenting behavior Parents Phase Procedures Protocols documentation Psychiatric therapeutic procedure Psychopathology Randomized Clinical Trials Randomized Controlled Trials Recording of previous events Regulation Relative (related person)Reporting Research Risk Risk Factors Self-Injurious Behavior Services Severities Subgroup Substance Use Disorder Suicide Suicide attempt Teenagers Testing Time Trauma Treatment Protocols Treatment outcome Visit Work active method base clinically significant depressive symptoms design drinking efficacy testing follow-up high risk improved intervention effect prevent programs public health relevance reducing suicide skills standard care suicidal suicidal adolescent suicidal behavior suicidal risk suicide attempter treatment as usual trial comparing

项目摘要

DESCRIPTION (provided by applicant): A significant subgroup of suicidal adolescents continues to demonstrate suicidal ideation and behavior after discharge from emergent psychiatric care. These adolescents are typically high utilizers of expensive follow-up psychiatric care after discharge from inpatient psychiatric settings. This group of adolescents is the focus of this application. We are aware of only 6 RCTs with suicidal adolescents, two using family therapy, two using group therapy, one using Multisystemic Therapy, and a study by our group using individual adolescent Cognitive Behavioral Therapy (Donaldson et al, 2005). Only one of these six studies reported a reduction in suicide attempts at follow-up. We recently completed a study (Esposito-Smythers et al, in press) using an integrated adolescent and parent CBT protocol for adolescents with depression, suicidality, and a substance use disorder. At follow-up, our protocol resulted in fewer suicide attempts, re-hospitalizations, ED (Emergency Department) evaluations, and residential placements relative to standard care. These data are remarkable for the cost savings in the experimental group if ED evaluations, repeat inpatient psychiatric hospitalizations and residential placements are considered. In addition, our 5% rate of repeat attempts in the experimental condition over 18 months is very low compared to naturalistic studies and other treatment studies. Our protocol required two therapists per family - one for the adolescent and one for the parent(s) due to the acuity and severity of these adolescents. Not all suicidal adolescents will need an intensive treatment protocol such as ours but many being discharged from inpatient psychiatric care will need such services. In this application, depressed, suicidal adolescents seeking emergency care in an ED or who are psychiatrically hospitalized are eligible for our study if they have at least one additional risk factor: a prior suicide attempt, nonsuicidal self-injury (NSSI), and/or a substance use disorder, because these factors are related to increased risk for continued suicidal behavior and expensive contacts with the health care system after discharge. These risk factors were also chosen for scientific reasons because they share common underlying mechanisms - affect regulation and impulse control - that can be addressed in an intensive treatment protocol. The purpose of this application is to conduct a two group randomized controlled trial to test the primary aim that an intensive protocol designed to treat depressed, suicidal adolescents with an additional complicating risk factor will produce better treatment outcomes compared to standard care at the end of the active treatment (6 months), end of maintenance treatment (12 months) and at the final follow-up point (18 months).. This application's clinical significance lies in its addresing a critical barrier to the field: how to best treat the most high risk, depressed and suicidal adolescents.

描述（由申请人提供）：自杀青少年的一个重要亚群在从紧急精神科护理出院后继续表现出自杀意念和行为。这些青少年通常高度利用昂贵的后续精神科治疗从精神病院出院后的护理。这群青少年是重点关注的对象这个应用程序。我们知道只有 6 项针对自杀青少年的随机对照试验，其中两项使用家庭治疗，两项使用团体治疗，一项使用多系统治疗，以及我们小组的一项研究使用个体青少年认知行为治疗（Donaldson 等，2005）。这六项研究中只有一项报告随访期间自杀企图有所减少。我们最近完成了一项研究（Esposito-Smythers 等人，待出版），针对患有抑郁症、自杀倾向和药物滥用障碍的青少年，采用综合青少年和家长 CBT 方案。在随访中，与标准护理相比，我们的方案减少了自杀企图、再住院、急诊室评估和住院安置。如果考虑到急诊室评估、重复住院精神科住院治疗和住院安置，这些数据对于实验组的成本节省是显着的。此外，与自然主义研究和其他治疗研究相比，我们在 18 个月的实验条件下重复尝试的 5% 率非常低。我们的协议要求每个家庭有两名治疗师 - 一名为青少年，一名为父母，因为这些青少年的敏锐度和严重程度。并非所有有自杀倾向的青少年都需要像我们这样的强化治疗方案，但许多从住院精神科护理中出院的青少年将需要此类服务。在此申请中，在急诊室寻求紧急护理或因精神病住院的抑郁、有自杀倾向的青少年，如果他们至少有一个额外的危险因素，则符合我们的研究资格：既往有自杀企图、非自杀性自伤 (NSSI) 和/或物质使用障碍，因为这些因素与持续自杀行为的风险增加以及出院后与医疗保健系统的昂贵联系有关。选择这些风险因素也是出于科学原因，因为它们具有共同的潜在机制 - 影响调节和冲动控制 - 可以在强化治疗方案中解决。本申请的目的是进行一项两组随机对照试验，以测试主要目的，即旨在治疗具有额外复杂危险因素的抑郁、自杀青少年的强化方案与标准护理相比，在治疗结束时将产生更好的治疗结果积极治疗（6 个月）、维持治疗结束（12 个月）和最后随访点（18 个月）。该应用的临床意义在于解决了该领域的一个关键障碍：如何最好地治疗最多的患者高风险、抑郁和有自杀倾向的青少年。