Identifying Periods of High Risk and Predictors of Suicide for Youth in Public Child Serving Systems

确定公共儿童服务系统中青少年自杀的高风险期和预测因素

基本信息

批准号：
9766393
负责人：
JEFFREY A BRIDGE
金额：
$ 41.5万
依托单位：
RESEARCH INST NATIONWIDE CHILDREN'S HOSP
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-17 至 2022-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9766393
关键词：
Accounting Address Adolescent Adolescent and Young Adult Advisory Committees Age Aging Agreement Algorithms Caring Cause of Death Cessation of life Child Child Welfare Communities County Data Data Sources Databases Development Ethnic Origin Exposure to Family Funding General Population Geography Goals Healthcare Home environment Incidence Individual Information Systems Inpatients Insurance Intervention Justice Life Link Longitudinal cohort study Low income Measures Medicaid Mental Health Mental disorders Methods Modeling Ohio Outcome Outpatients Population Prevention program Problem Solving Public Health Race Research Research Project Grants Resources Risk Risk Factors Service setting Services Statistical Models Subgroup Suicide Suicide attempt Suicide prevention Surgeon System Testing Therapeutic Intervention Time United States Vision Vital Statistics Work Youth addiction age group aged base behavioral health care systems contextual factors data sharing design experience foster care high risk innovation insight intervention program multidisciplinary novel population based prediction algorithm programs prospective public health relevance reducing suicide response sex suicidal morbidity suicidal risk suicide rate targeted treatment tool young adult

项目摘要

Abstract Suicide is now the second leading cause of death in youth aged 10-24 years, accounting for more deaths in this age group than all those for ten other leading causes of death combined. The vision of the U.S. Surgeon General and the National Action Alliance for Suicide Prevention (Action Alliance) is “a nation free from the tragic experience of suicide.” In pursuit of this vision, the Action Alliance's Research Prioritization Task Force (RPTF) released a research agenda aimed at reducing suicide deaths and suicide attempts 20 percent by 2025. To achieve this ambitious goal, the RPTF has recommended strategically targeting interventions at population subgroups at high risk for suicide in designated “boundaried settings”. Youth in publicly funded systems of care (e.g., Medicaid, child welfare, juvenile justice, and behavioral health) represent an especially large and important “boundaried population” at heightened risk of suicide and mental illness relative to youth in the general population. Unfortunately, despite the large numbers of vulnerable youth in publicly funded programs, little is known about the rates and predictors of suicide for this population. This research project proposes to create, for the first time, an integrated population-based database that links 9 years of data across multiple Ohio child-serving agencies. This is a unique suicide prevention resource currently unmatched by any federal data system. This research has the potential to provide in depth prospective information concerning interactions between dynamic individual and contextual factors that might be fruitfully applied to the development of targeted suicide prevention and intervention programs. Specific aims of this proposed research are three-fold: 1) to quantify the incidence of suicide across and within 4 public child-serving systems in Ohio; 2) to identify high risk periods for suicide among youth in publicly funded sectors; and 3) to develop and validate a risk prediction algorithm to estimate individual risk for suicide in this population. Our central hypothesis is that entry to and exits from child welfare and juvenile justice programs will be associated with increased risk for suicide as will major transitions across levels of mental health care (e.g., moving from inpatient to outpatient). This retrospective longitudinal cohort study will use data on 2.2 million youth in public child serving systems aged 10-24 years who will be followed from 2010 to 2018. We employ a novel multistate statistical modeling approach to test hypotheses about transitions of care (Aim 2) and time-dependent Cox regression to examine predictors of suicide for youth in public child serving systems (Aim 3). The results of this innovative study will identify high-risk transition periods and contribute to a better understanding of risk for suicide among youth in publicly funded systems. Feasibility is supported by an existing commitment from our state partners to provide the linked data necessary to accomplish our objectives.

抽象的自杀现在是 10-24 岁青少年的第二大死因，在这个年龄段的人比美国外科医生的其他十个主要死因的总和还要多。总则和全国预防自杀行动联盟（行动联盟）是“一个没有自杀倾向的国家” 为了实现这一愿景，行动联盟的研究优先任务组 (RPTF) 发布了一项研究议程，旨在通过以下方式将自杀死亡和自杀企图减少 20%： 2025 年。为了实现这一雄心勃勃的目标，RPTF 建议采取战略性干预措施在公共资助的指定“边界环境”中自杀的高风险人群。护理系统（例如医疗补助、儿童福利、少年司法和行为健康）尤其代表了与年轻人相比，大量重要的“边缘人群”面临自杀和精神疾病胃肠道风险不幸的是，尽管公共资助中存在大量弱势青年。该研究项目对这一人群的自杀率和预测因素知之甚少。提议首次创建一个基于人口的综合数据库，将 9 年的数据链接起来俄亥俄州多个儿童服务机构这是目前任何其他机构都无法比拟的独特的自杀预防资源。这项研究有可能提供有关联邦数据系统的深入前瞻性信息。动态个体和环境因素之间的相互作用可能会有效地应用于制定有针对性的自杀预防和干预计划。包括三个方面：1) 量化俄亥俄州 4 个公共儿童服务系统内的自杀发生率； 2) 确定公共资助部门中青少年自杀的高风险期；以及 3) 制定和制定验证风险预测算法来估计该人群的个体自杀风险。假设是，儿童福利和少年司法计划的进入和退出将与自杀风险增加，精神卫生保健水平的重大转变也会增加（例如，从这项回顾性纵向队列研究将使用 220 万公共场所青少年的数据。 10-24 岁的儿童服务系统，将在 2010 年至 2018 年期间进行跟踪。我们采用了一种新颖的多状态用于检验有关护理转变（目标 2）和时间依赖性 Cox 的假设的统计建模方法回归分析公共儿童服务系统中青少年自杀的预测因素（目标 3）。创新研究将确定高风险过渡期，并有助于更好地了解风险公共资助系统中青少年自杀的可行性得到了我们现有承诺的支持。国家合作伙伴提供实现我们目标所需的链接数据。