STAT-ED Suicidal Teens Accessing Treatment after an Emergency Department Visit

STAT-ED 自杀青少年在急诊科就诊后接受治疗

• 批准号: 8731629
• 负责人: JEFFREY A BRIDGE
• 金额: $ 39.96万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2016-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8731629
• 关键词: STAT; ED; Suicidal; Teens; Accessing

DESCRIPTION (provided by applicant): While many young patients at risk for suicide present to the emergency department (ED) following suicide attempts or in situations of extreme suicidal crises, other patients at risk for suicide go unrecognized, and therefore untreated, in the ED. Once discharged, 30% of suicidal adolescents return to the ED with another crisis within six months of the sentinel event. Currently, no evidence-based standards exist for appropriate screening and post-screening interventions in order to improve outcomes for patients presenting in EDs who are at elevated risk for suicidal behavior. This two-site R01 application tests the effectiveness of a brief treatment engagement intervention termed Suicidal Teens Accessing Treatment after an ED Visit (STAT-ED) for adolescents seeking treatment in the ED for non-psychiatric concerns but identified via systematic screening as being at risk for suicide. In this unique 3-year proposal, investigators from two institutions (Cincinnati Children's Hospital Medical Center [CCHMC] and Nationwide Children's Hospital [NCH]) will recruit and randomize 160 adolescents (80 per site) to (a) the STAT-ED intervention or (b) enhanced usual care (EUC) as a comparison condition. EUC consists of a brief consultation and a mental health referral. The STAT-ED intervention targets family engagement, problem solving, assistance with referral and limited case management during the transition from the ED to outpatient care with the goal of maximizing the initiation of mental health treatment and aftercare among youth screening positive for previously unrecognized suicide risk. The application builds on a pilot study in which STAT-ED was well- accepted by patients, families, and clinicians and was more effective than EUC. We now propose to test the STAT-ED intervention against EUC in a larger, more diverse sample from two geographically separate, urban pediatric EDs serving broad populations (Cincinnati and Columbus, Ohio). A second aim is to compare the effectiveness of STAT-ED and EUC in reducing suicidal ideation and depression symptoms after ED discharge. The rationale is that by using the pediatric ED to identify and treat unrecognized suicide risk, adolescents will be less likely to overuse ED services in the future, have a better quality of life and ultimately have a reduced risk of morbidity and mortality. If successful, it will provide a brif and sustainable intervention that can be implemented across diverse pediatric ED settings. This study will contribute to the mission of the CDC by improving our capacity to identify "best practices" for screening, assessing, and implementing practical suicide prevention interventions in the pediatric ED setting.

描述（由申请人提供）：虽然许多有自杀风险的年轻患者在自杀未遂或处于极端自杀危机的情况下到急诊科 (ED) 就诊，但其他有自杀风险的患者在急诊室未被识别，因此得不到治疗。出院后，30% 的自杀青少年在哨兵事件发生后六个月内再次出现危机而返回急诊室。目前，尚无基于证据的标准来进行适当的筛查和筛查后干预，以改善自杀行为风险较高的急诊科患者的治疗结果。这个两个站点的 R01 应用程序测试了一项名为“自杀青少年在急诊室就诊后接受治疗”(STAT-ED) 的简短治疗参与干预措施的有效性，该干预措施针对因非精神问题而在急诊室寻求治疗但通过系统筛查确定为有风险的青少年为了自杀。在这项独特的 3 年提案中，来自两个机构（辛辛那提儿童医院医疗中心 [CCHMC] 和全国儿童医院 [NCH]）的研究人员将招募 160 名青少年（每个中心 80 名）并随机分配到 (a) STAT-ED 干预或(b) 强化常规护理（EUC）作为比较条件。 EUC 包括简短的咨询和心理健康转介。 STAT-ED 干预措施的目标是在从急诊室过渡到门诊护理期间，家庭参与、解决问题、协助转诊和有限的病例管理，目的是最大限度地启动对先前未认识到的自杀风险筛查呈阳性的青少年的心理健康治疗和善后护理。该应用程序建立在一项试点研究的基础上，其中 STAT-ED 受到患者、家属和临床医生的广泛接受，并且比 EUC 更有效。我们现在建议在更大、更多样化的样本中测试针对 EUC 的 STAT-ED 干预措施，样本来自两个地理位置不同的城市儿科急诊室（辛辛那提和俄亥俄州哥伦布）。第二个目的是比较 STAT-ED 和 EUC 在减少 ED 出院后的自杀意念和抑郁症状方面的有效性。其基本原理是，通过使用儿科急诊室来识别和治疗未被识别的自杀风险，青少年未来将不太可能过度使用急诊室服务，获得更好的生活质量，并最终降低发病和死亡的风险。如果成功，它将提供一种简短且可持续的干预措施，可以在不同的儿科急诊机构中实施。这项研究将提高我们确定“最佳实践”的能力，以在儿科急诊室中筛查、评估和实施实用的自杀预防干预措施，从而为疾病预防控制中心的使命做出贡献。

项目成果

Effect of a Motivational Interviewing-Based Intervention on Initiation of Mental Health Treatment and Mental Health After an Emergency Department Visit Among Suicidal Adolescents: A Randomized Clinical Trial.

基于动机访谈的干预措施对自杀青少年急诊科就诊后开始心理健康治疗和心理健康的影响：一项随机临床试验。

• 发表时间: 2019
• 影响因子: 13.8
• 作者: Grupp;Stevens, Jack;Boyd, Stephanie;Cohen, Daniel M;Ammerman, Robert T;Liddy;Heck, Kendra;Marcus, Steven C;Stone, Lara;Campo, John V;Bridge, Jeffrey A
• 通讯作者: Bridge, Jeffrey A

Emergency department recognition of mental disorders and short-term outcome of deliberate self-harm.

急诊科对精神障碍和故意自残的短期结果的认识。

• 发表时间: 2013-12
• 作者: Olfson, Mark;Marcus, Steven C;Bridge, Jeffrey A
• 通讯作者: Bridge, Jeffrey A

Suicide Trends Among Elementary School-Aged Children in the United States From 1993 to 2012.

1993 年至 2012 年美国小学生自杀趋势。

• 发表时间: 2015-07
• 影响因子: 26.1
• 作者: Bridge, Jeffrey A;Asti, Lindsey;Horowitz, Lisa M;Greenhouse, Joel B;Fontanella, Cynthia A;Sheftall, Arielle H;Kelleher, Kelly J;Campo, John V
• 通讯作者: Campo, John V

Suicide in Elementary School-Aged Children and Early Adolescents.

小学生和青少年早期的自杀。

• 发表时间: 2016
• 影响因子: 8
• 作者: Sheftall, Arielle H;Asti, Lindsey;Horowitz, Lisa M;Felts, Adrienne;Fontanella, Cynthia A;Campo, John V;Bridge, Jeffrey A
• 通讯作者: Bridge, Jeffrey A