Development and Pilot Study of Primary Care Loneliness Interventions to Prevent Suicide

预防自杀的初级保健孤独干预措施的开发和试点研究

基本信息

批准号：
10646959
负责人：
Paul Nelson Pfeiffer
金额：
$ 23.4万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-15 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10646959
关键词：
Academy Acceleration Address Adopted Adult Anxiety Anxiety Disorders Behavior Therapy COVID-19 pandemic Caring Case Manager Cause of Death Chronic Clinic Clinical Cognitive Cognitive Therapy Collaborations Communities Development Education Effectiveness Effectiveness of Interventions Eligibility Determination Engineering Enrollment Epidemic Exercise Feeling suicidal Frequencies Future Health Services Health system Hybrids Impairment Intervention Investigational Therapies Lead Link Loneliness Managed Care Managed Care Programs Manuals Measures Medicare Medicine Mental Depression Mental Health Meta-Analysis Modeling Outcome Participant Patients Pharmacotherapy Pilot Projects Prevalence Primary Care Production Protocols documentation Provider Psychiatry Public Health Randomized Recovery Research Risk Factors Role Science Services Site Social Interaction Social isolation Suicide Suicide prevention Surgeon Testing Therapeutic Intervention Time Training acceptability and feasibility arm behavioral health collaborative care community organizations comorbid depression design effectiveness evaluation effectiveness trial expectation experience follow up assessment health care settings health related quality of life implementation/effectiveness improved innovation lonely individuals mortality patient engagement patient response pilot test primary care clinic primary care practice primary care provider primary outcome reducing suicide secondary outcome social social engagement social health determinants structural determinants suicidal behavior suicidal morbidity suicidal risk three-arm trial tool treatment arm treatment as usual volunteer

项目摘要

Project Summary/Abstract Suicide is a leading cause of death in the US with an estimated 46,000 suicide deaths occuring in 2020. Loneliness, an interpersonal risk factor for suicide, was recognized as having reached epidemic proportions by the US Surgeon General in 2017 before rates further worsened due to the COVID-19 pandemic. Given the public health impact of loneliness, the National Academies of Engineering, Sciences, and Medicine have called for health systems to take an active role and intervene to reduce loneliness. Primary care is the optimal health system setting to deliver loneliness interventions to prevent suicide because primary care increasingly screens for loneliness along with other social determinants of health. Primary care practices also increasingly employ behavioral health care managers who can deliver loneliness interventions along with treatments for depression and anxiety disorders that may impair recovery from chronic loneliness and contribute to suicide risk. Prior primary care approaches to loneliness have had mixed results and there remains no established, effective, ready-to-adopt model to reduce loneliness and suicidal ideation in primary care. This study will adapt two loneliness interventions, social prescribing and brief cognitive therapy, to be delivered within primary care. Social prescribing addresses the structural determinants of loneliness (i.e., breadth and frequency of social interactions) by linking patients to community-based organizations or activities (e.g., volunteering) whereas brief cognitive therapy addresses the cognitive determinants of loneliness (i.e., relationship expectations) through education, reflections, and guided exercises. In contrast to prior studies, both interventions will be adapted to be delivered by a behavioral health care manager working within a primary care-based collaborative care management program. The specific aims of the project are: 1) Adapt social prescribing and brief cognitive therapy interventions for loneliness to be delivered as components of primary care collaborative care management and 2) conduct a randomized controlled pilot study (N=60) to determine feasibility and acceptability of the two interventions and trial protocols. The Aim 1 development activities will be guided by the ADAPT-ITT (assessment, decision, administration, production, topical experts, integration, training, testing) framework and will engage patient and provider stakeholders to inform production of manuals to guide training and pilot testing of the interventions. In the Aim 2 pilot study, patients from two primary care sites who screen positive for loneliness and suicidal ideation will be randomly assigned to one of the two interventions or to EUC. At 3 months, participants in the intervention arms will receive the alternate intervention for an additional 3 months, and EUC participants will continue to receive EUC. Feasibility and acceptability will be measured to inform a future adequately powered trial to determine the interventions’ mechanisms and effectiveness for reducing loneliness and suicidal ideation.

项目摘要/摘要自杀是美国的主要死亡原因，估计在2020年发生了46,000例自杀死亡。孤独感是自杀的一种人际交往风险因素，被认为已经达到了流行比例 2017年，美国外科医生由于19号大流行而在2017年进一步降低了比率。鉴于孤独，国家工程学，科学和医学学院对公共卫生的影响让卫生系统发挥积极作用并干预以减少孤独感。初级保健是最佳健康进行孤独干预以防止自杀的系统设置，因为初级保健越来越多地筛选孤独以及其他社会决定者。初级保健实践也越来越多地采用可以提供孤独干预以及抑郁症治疗的行为医疗保健经理以及可能会损害慢性孤独感并导致自杀风险的焦虑症。事先的孤独的初级保健方法的结果好坏参半，没有建立，有效的，即将添加的模型，以减少初级保健中的孤独和自杀想法。这项研究将适应两种孤独干预措施，社会处方和简短的认知疗法在初级保健中。社会处方介绍了孤独的结构决定者（即广度和广度社交互动的频率）通过将患者与社区组织或活动联系起来（例如，志愿服务），而简短的认知疗法旨在解决孤独的认知决定者（即关系期望）通过教育，思考和指导练习。与先前的研究相反，两种干预措施都将改编成由行为医疗保健经理提供的基于初级保健的协作护理管理计划。该项目的具体目的是：1）适应社会处方和简短的认知疗法干预措施，以作为孤独感作为组成部分初级保健协作护理管理和2）进行随机对照试验研究（n = 60）确定两种干预措施和试验方案的可行性和可接受性。 AIM 1开发活动将由Adapt-Itt指导（评估，决策，行政管理，生产，局部专家，集成，培训，测试）框架，并将吸引患者和提供者利益相关者为制作手册提供指导干预措施的培训和试点测试。目的 2个试点研究，来自两个初级保健网站的患者筛选孤独和自杀想法的阳性被随机分配给两种干预措施之一或EUC。在三个月时，干预参与者武器将再进行另外三个月的替代干预，EUC参与者将继续接收EUC。将衡量可行性和可接受性，以告知将来的充分动力试验确定干预措施的机制和有效性，以减少孤独和自杀思想。