Collaborative Hub to Reduce the Burden of Suicide among Urban American Indian and Alaska Native Youth

减轻城市美洲印第安人和阿拉斯加原住民青年自杀负担的合作中心

基本信息

批准号：
10186827
负责人：
SPERO MARTIN MANSON
金额：
$ 82.63万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-08-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10186827
关键词：
Accreditation Address Adoption Affect Age Alaska Alaska Native American Indians American Psychiatric Association Behavior Caring Cause of Death Cessation of life Clinic Clinical Communication Methods Communities Current Procedural Terminology Codes Data Detection Environment Equation Event Evidence based intervention Evidence based practice Face Family Feeling suicidal Health Health Technology Healthcare Hospitalization Institutes Intervention Joints Life Marriage Mediating Mental Depression Mental Health Mental disorders Outcome Participant Patient Care Patient Self-Report Patients Population Pregnancy in Adolescence Prevention Research Primary Health Care Process Protocols documentation Public Health Practice Quality of life Randomized Randomized Controlled Trials Reporting Research Reservations Resources Risk Risk Factors Rural Services Site Structure Substance abuse problem Suicide Suicide attempt Suicide prevention Surgeon System Testing Text Messaging Thinking Time Treatment outcome Triage Tribes Work Youth base behavioral health behavioral health intervention care providers compare effectiveness cost effective economic evaluation effective intervention evidence base follow-up gang health care service organization health organization help-seeking behavior high risk improved innovation intervention effect mHealth native youth novel primary outcome protective factors psychological trauma reducing suicide response screening screening, brief intervention, referral, and treatment secondary outcome social social stigma stem success suicidal behavior suicidal risk suicide rate treatment as usual treatment program urban Native American urban area young adult

项目摘要

ABSTRACT Suicide is the second leading cause of death for American Indian and Alaska Native (AI/ANs) ages 10-34, while rates for AI/ANs younger than 25 years are up to 6 times higher than for Whites of similar ages. Most research has been limited to rural reservation settings, yet 71% of AI/ANs reside in urban areas. This “invisible tribe” faces unique challenges stemming from its lack of connection with traditional family and cultural environments. Urban AI/AN youth and young adults are at notably higher risk than their non-AI/AN counterparts for attempted suicide (21% vs. 7%), and for serious mental health problems, substance abuse, gang activity, teen pregnancy, and interpersonal abuse. Yet, most people who die by suicide have contact with a primary care provider in the prior year, and 45% are seen in the month before their death. “Screening, Brief Intervention, and Referral to Treatment” (SBIRT) is an evidence-based practice that co-locates behavioral health clinicians in primary care teams and substantially reduces suicide risk through immediate intervention by behavioral health clinicians. However, retention in SBIRT has been a challenge and it has not been tested in urban AI/ANs to screen for suicidality (suicidal thoughts or behaviors). We have partnered with 2 large Urban Indian Health Organizations – the Seattle Indian Health Board and First Nations Community Healthsource in Albuquerque to evaluate their existing SBIRT programs. We will also test a novel enhancement that sends caring text messages, which have been adapted from similar empirically-based, effective interventions for suicide prevention. The text messages are intended to improve SBIRT retention and increase social and cultural connectedness, which are strong protective factors against suicidality and death. During the 3-year study, we will randomly assign 2,400 AI/AN patients ages 12-34 who screen positive for suicidal ideation to usual care (SBIRT+referral to existing resources) or SBIRT with either 6 months (SBIRT+6) or 12 months (SBIRT+12) of text messages. Primary outcomes will be self-reported suicidal ideation, attempts, and suicide- related hospitalizations for 1 year after randomization. Secondary outcomes will include perceived social connectedness and retention. Given the value of sustainability, we will also conduct an economic evaluation. Our Specific Aims are to: 1) Evaluate SBIRT programs at our study sites to identify and address factors that affect their successful implementation; 2) Compare the effectiveness of SBIRT+6 and SBIRT+12 to usual care for reducing suicidal ideation, attempts, and hospitalizations; and for increasing social connectedness and retention in SBIRT; and 3) Perform an rigorous economic evaluation of SBIRT+6 and SBIRT+12 compared to usual care to examine their effects on use of healthcare resources and quality of life. Given the stigma attached to mental illness, few AI/AN youth and young adults seek help for suicidality. Challenges of retention and follow-up underscore the need for innovative means of engagement beyond the clinic. Our work is aligned with the Surgeon General's National Strategy for Suicide Prevention that identifies connectedness to others as the primary protective factor against suicidality.

抽象的自杀是 10-34 岁美洲印第安人和阿拉斯加原住民 (AI/AN) 的第二大死因，而 25 岁以下的 AI/AN 的发病率比同龄白人高出 6 倍。研究仅限于农村保留地，但 71% 的 AI/AN 居住在城市地区。 “部落”面临着独特的挑战，因为它与传统家庭和文化缺乏联系。城市 AI/AN 青少年和年轻人比非 AI/AN 面临的风险明显更高。自杀未遂（21% vs. 7%），以及严重的心理健康问题、药物滥用、然而，大多数自杀身亡的人都与帮派活动、青少年怀孕和人际虐待有过接触。上一年曾接受过初级保健提供者的治疗，45% 的人是在去世前一个月接受过治疗。干预和转诊治疗”（SBIRT）是一种基于证据的实践，将行为初级保健团队中的健康战士，并通过立即干预大大降低自杀风险然而，SBIRT 的保留一直是一个挑战，而且还没有经过测试。城市人工智能/AN 筛查自杀想法或行为我们与 2 个大型城市合作。印第安人卫生组织 – 西雅图印第安人卫生委员会和原住民社区健康资源阿尔伯克基评估他们现有的 SBIRT 程序，我们还将测试一种发送的新颖增强功能。关怀短信，改编自类似的基于经验的有效干预措施这些短信旨在提高 SBIRT 保留率并增强社交和预防自杀的能力。文化联系，这是三年内防止自杀和死亡的强有力的保护因素。研究中，我们将随机分配 2,400 名 12-34 岁的自杀意念筛查阳性的 AI/AN 患者常规护理（SBIRT+转介至现有资源）或 6 个月 (SBIRT+6) 或 12 个月的 SBIRT (SBIRT+12) 短信的主要结果将是自我报告的自杀意念、企图和自杀。随机分组后一年的相关住院情况将包括感知的社会情况。考虑到可持续性的价值，我们还将进行经济评估。我们的具体目标是： 1) 评估我们研究地点的 SBIRT 计划，以确定并解决影响因素 2) 比较 SBIRT+6 和 SBIRT+12 与常规护理的有效性减少自杀念头、自杀企图和住院治疗；以及增加社会联系和 SBIRT 中的保留率；以及 3) 对 SBIRT+6 和 SBIRT+12 进行严格的经济评估考虑到耻辱，检查它们对医疗资源使用和生活质量的影响。由于患有精神疾病，很少有 AI/AN 青少年和年轻人寻求自杀方面的帮助。和后续行动强调了临床以外创新参与方式的必要性。外科医生的国家自杀预防战略将与他人的联系确定为防止自杀的主要保护因素。