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：
8692492
负责人：
CHRISTIANNE L. ESPOSITO-SMYTHERS
金额：
$ 70.9万
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/8692492
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 Department evaluation Emergency Situation 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 inpatient psychiatric treatment 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）：自杀青少年的重要亚组继续表现出从新兴的精神病护理中解除后的自杀念头和行为。这些青少年通常是昂贵的随访精神病的高利用率从住院精神病患者出院后的护理。这群青少年是此应用程序。我们知道只有6种具有自杀青少年的RCT，两名使用家庭疗法，两项使用组疗法，一种使用多系统治疗的RCT，以及我们小组使用单个青少年认知行为疗法的研究（Donaldson等，2005）。这六项研究中只有一项报告报告了自杀尝试减少了随访。最近，我们使用集成的青少年和母体CBT方案完成了一项研究（Esposito-Smythers等人，印刷中），用于抑郁，自杀和药物使用障碍的青少年。在随访时，我们的协议导致相对于标准护理的自杀企图，重新建筑（ED（急诊科）评估（急诊科）评估以及住宅安置。如果考虑了ED评估，重复住院精神病医院的住院和住宅安置，则这些数据对于实验组的成本节省而言是显着的。此外，与自然研究和其他治疗研究相比，在18个月内，我们在实验条件下的重复尝试率很低。我们的方案每个家庭需要两名治疗师 - 一个用于青少年的治疗师，另一个是由这些青少年的敏锐度和严重程度。并非所有自杀青少年都需要像我们这样的强化治疗方案，但是许多人从住院的精神病护理中出院将需要此类服务。在此应用中，如果他们至少有一个额外的危险因素，则有资格在急诊室或精神上住院的沮丧，自杀的青少年有资格进行我们的研究：先前的自杀未遂，非杀伤性自我伤害（NSSI）（NSSI）（NSSI）和/或药物使用障碍，以及与持续的较昂贵的健康相关的，因为这些因素与较高的保健相关。由于科学原因，选择这些危险因素，因为它们具有共同的潜在机制 - 影响调节和冲动控制 - 可以通过强化治疗方案解决。该应用的目的是进行两组随机对照试验，以测试旨在治疗具有额外复杂危险因素的抑郁，自杀的青少年的密集协议，将产生更好的治疗结果，与活跃治疗结束时（6个月）（6个月），维护治疗结束（12个月）和最终的临床待遇（18个月）。最高风险，沮丧和自杀的青少年。