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.

项目概要 增强有自杀风险的青少年积极性的技能 过去两年青少年的自杀率和自杀行为稳步上升 几十年。不幸的是，对已发表的青少年自杀随机对照试验（RCT）的回顾 得出的结论是，迄今为止的治疗效果甚微，特别是与成人试验相比。 干预措施的优势集中在危机干预、精神障碍、调节 负面影响，减少认知扭曲。然而，我们的试点工作和其他最近的数据表明 考虑低积极情感可能是导致自杀的机制的重要性 独立于其他风险因素的行为。因此，我们制定了一项干预措施，即“增强技能” 积极性（STEP；MH R34101272），以积极情感的扩大和建立理论为前提，增加 对积极情感和经历的关注和认识。我们的试点随机对照试验 (N=52) 的结果 住院的自杀青少年发现，与常规的健康习惯/强化治疗相比 (ETAU) 条件下，那些随机分配到 STEP 的人报告自杀事件的人数减少了 50%，减少了 50% 总体而言，自杀事件以及报告主动自杀意念 (SI) 的参与者大幅减少 上升（49% STEP vs. 19.2% ETAU）。 STEP 似乎也与 STEP 一样参与了目标机制 与 ETAU 相比，参与者对注意力偏差任务中的积极探索有更快的反应时间，并且 只有处于STEP状态的人在感恩和生活满意度方面报告了显着的前后差异。 这些有希望的结果，我们能够证明目标的参与（积极影响）和 临床结果（自杀事件）的减少表明需要通过以下方式测试 STEP 的临床有效性： 让临床工作人员实施干预。此外，认识到加快翻译速度的必要性，我们 提出混合型 I 型有效性实施设计。具体来说，我们建议测试 STEP 在减少 216 名住院青少年的自杀事件和意念方面的有效性 由于自杀风险而进行的精神护理。参与者将被随机分配到 STEP 或 ETAU。 STEP涉及4个 面对面课程（3个人，1个家庭），重点是教授积极和消极情感的心理教育， 正念冥想、感恩和品味。带有情绪监测提示的数字健康信息和 出院后第一个月每天发送技能提醒，接下来的两个月每周发送 3 次技能提醒 几个月。 ETAU 条件将收到每日提醒，登录安全资源应用程序。我们假设 那些被随机分配到STEP（相对于ETAU）的人将有更少的自杀事件、意念、抑郁和经历 积极情绪和对积极情绪的关注增加，消极情绪和对积极情绪的关注减少 负面影响，通过隐性任务和自我报告措施来衡量。设计的有效性方面 包括使用临床工作人员作为干预人员，并且参与的排除标准很少。 实施方面包括为提高现实世界实践的采用率提供策略信息的数据。

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