Skills to Enhance Positivity (STEP) for Adolescents at Risk for Suicide

增强自杀风险青少年积极性的技能 (STEP)

• 批准号: 10683179
• 负责人: Anthony Spirito
• 金额: $ 75.69万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-19 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10683179
• 关键词: Address; Administrator; Admission activity; Adolescent; Adult; Affect; Affective; Attention; Awareness; Clinical; Clinical effectiveness; Cognitive; Community Practice; Crisis Intervention; Data; Distal; Educational process of instructing; Effectiveness; Effectiveness of Interventions; Elements; Emergency Situation; Event; Exclusion Criteria; Family; Feeling suicidal; Frequencies; Future; Habits; Healthy People 2020; Hybrids; Individual; Inpatients; Intervention; Interview; Life; Longterm Follow-up; Measures; Mediating; Mental Depression; Mental disorders; Monitor; Moods; National Institute of Mental Health; Outcome; Parents; Participant; Patient Self-Report; Patients; Perception; Persons; Public Health; Publishing; Randomized; Randomized, Controlled Trials; Reaction Time; Reporting; Research; Resources; Risk Factors; Safety; Self Assessment; Speed; Strategic Planning; Suicide; Suicide attempt; Surveys; Testing; Translations; Work; Youth; acceptability and feasibility; acute care; attentional bias; design; digital health; effectiveness evaluation; effectiveness research; effectiveness testing; effectiveness/implementation design; effectiveness/implementation study; effectiveness/implementation trial; experience; follow-up; gratitude; high risk; ideation; implementation barriers; implementation strategy; improved; inpatient psychiatric treatment; interest; mindfulness meditation; multimodality; negative affect; practice setting; primary outcome; programs; psychoeducation; psychoeducational; reducing suicide; satisfaction; secondary outcome; skills; standardize measure; suicidal; suicidal adolescent; suicidal behavior; suicidal risk; suicide rate; theories; treatment as usual; uptake

PROJECT SUMMARY SKILLS TO ENHANCE POSITIVITY IN ADOLESCENTS AT RISK FOR SUICIDE Rates of suicide and suicidal behavior in adolescents have been steadily increasing over the past two decades. Unfortunately, reviews of published randomized controlled trials (RCTs) for adolescent suicidality conclude that treatments to date have been minimally efficacious, particularly when compared to adult trials. The preponderance of interventions focus on crisis intervention, underling psychiatric disorders, regulating negative affect, and reducing cognitive distortions. However, our pilot work and other recent data suggest the importance of considering how low positive affectivity may be a mechanism that contributes to suicidal behaviors independent of other risk factors. Therefore, we developed an intervention, Skills to Enhance Positivity (STEP; MH R34101272), premised on the Broaden and Build theory of positive affect, to increase attention to, and awareness of positive affect and experiences. Results from our pilot RCT (N=52) with inpatient suicidal adolescents found that compared to a Healthy Habits / Enhanced Treatment as Usual (ETAU) condition, those randomized to STEP had 50% fewer individuals reporting a suicidal event, 50% fewer suicidal events overall, and a larger decrease in participants reporting active suicidal ideation (SI) over follow up (49% STEP vs. 19.2% ETAU). STEP also appears to have engaged the target mechanism as STEP participants had faster reaction times to positive probes on an attentional bias task compared to ETAU, and only those in the STEP condition reported significant pre-post differences on gratitude and satisfaction with life. These promising results in which we were able to demonstrate engagement of the target (positive affect) and a decrease in clinical outcomes (suicidal events) suggest the need to test the clinical effectiveness of STEP by having clinical staff implement the intervention. Furthermore, recognizing the need to speed translation, we propose a Hybrid Type I Effectiveness-Implementation design. Specifically, we propose to test the effectiveness of STEP in reducing suicidal events and ideation in 216 adolescents, admitted to inpatient psychiatric care due to suicide risk. Participants will be randomized to either STEP or ETAU. STEP involves 4 in-person sessions (3 individual, 1 family) focused on teaching psychoeducation of positive and negative affect, mindfulness meditation, gratitude, and savoring. Digital health messages with mood monitoring prompts and skills reminders will be sent daily for the first month post-discharge and three times a week for the following two months. ETAU condition will receive daily reminders to log into a safety resource app. We hypothesize that those randomized to STEP (vs. ETAU) will have less suicide events, ideation, and depression, and experience increased positive affect and attention to positive affect, and decreased negative affect, and attention to negative affect, as measured by implicit tasks and self-report measures. Effectiveness aspects of the design include using clinical staff as interventionists and having very few exclusion criteria for participation. Implementation aspects include data to inform strategies to increase uptake in real world practice.

项目摘要 提高自杀风险的青少年积极性的技能 在过去两个 几十年。不幸的是，对青少年自杀的已发表随机对照试验（RCT）的评论 得出结论，迄今为止的治疗方法至少有效，尤其是与成人试验相比。 干预措施的大量重点是危机干预，基于精神疾病，调节 负面影响并减少认知扭曲。但是，我们的飞行员工作和其他最新数据表明 考虑到有助于自杀的机制可能有多么低的积极情感能力的重要性 行为与其他风险因素无关。因此，我们开发了一种干预措施，以提高技能 积极性（步骤; MH R34101272）以扩大和建立积极影响理论为前提，以增加 注意积极影响和经验的意识。我们的飞行员RCT（n = 52）的结果 住院自杀青少年发现，与往常一样的健康习惯 /增强治疗相比 （ETAU）条件，那些随机阶跃的人的报告少50％，报告了自杀事件，少50％ 自杀事件总体上，参与者报告主动自杀念头（SI）的参与者较大。 UP（49％步骤vs. 19.2％ETAU）。步骤似乎也将目标机制与步骤相关 与ETAU相比 只有那些处于步骤条件的人才能在对生活的感激和满意度上有显着的前差异。 这些有希望的结果，我们能够证明目标的参与（积极影响）和A 临床结果的减少（自杀事件）表明需要测试步骤的临床有效性 让临床人员实施干预措施。此外，认识到需要加快翻译的需要，我们 提出了I型I型有效性实施设计。具体来说，我们建议测试 步骤减少216名青少年的自杀事件和构想的有效性 由于自杀风险而导致的精神病护理。参与者将被随机分为步骤或ETAU。步骤涉及4 面对面的会议（3个个人，1个家庭）致力于教授积极和负面影响的心理教育， 正念冥想，感激和品味。数字健康消息带有情绪监控提示和 技能提醒将每天在入院后第一个月发送，每周三次，以下两个 月份。 ETAU条件将每天提醒以登录安全资源应用程序。我们假设这一点 那些随机步骤（与ETAU）的自杀事件，念头和沮丧和经验将较少 增加积极影响和对积极影响的关注，减少负面影响，并注意 通过隐式任务和自我报告措施来衡量的负面影响。设计的有效方面 包括将临床人员用作干预主义者，并且参与的排除标准很少。 实施方面包括数据，以告知策略以增加现实世界实践中的吸收。

项目成果

Skills to Enhance Positivity in adolescents at risk for suicide: Protocol for a randomized controlled trial.

• DOI: 10.1371/journal.pone.0287285
• 发表时间: 2023
• 期刊: PLOS ONE
• 影响因子: 3.7
• 作者: Yen, Shirley;Suazo, Nazaret;Doerr, Jackson;Macrynikola, Natalia;Villarreal, Leanna S.;Sodano, Sophia;O'Brien, Kimberly H. M.;Wolff, Jennifer C.;Breault, Christopher;Gibb, Brandon E.;Elwy, Rani;Kahler, Christopher W.;Ranney, Megan;Jones, Richard;Spirito, Anthony
• 通讯作者: Spirito, Anthony