Development of a mobile heath augmented brief suicide prevention intervention for people with SMI accessing community care

开发移动健康增强了 SMI 患者获得社区护理的简短自杀预防干预措施

• 批准号: 9370600
• 负责人: Colin A. Depp
• 金额: $ 23.25万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9370600
• 关键词: Advocate; Ambulatory Care; Appointment; Assertiveness; Behavior; Belief; Benchmarking; Bipolar Disorder; Caring; Clinic; Cognitive; Cognitive Therapy; Communities; Community Networks; Continuity of Patient Care; Coping Behavior; Data; Development; Diagnosis; Effectiveness; Effectiveness of Interventions; Enrollment; Evaluation; Exhibits; Feeling suicidal; Goals; Healthcare; Individual; Intervention; Mental Health; Mental disorders; Modeling; Outcome; Outpatients; Participant; Patients; Persons; Population; Preventive Intervention; Procedures; Program Effectiveness; Protocols documentation; Provider; Psychological reinforcement; Psychotic Disorders; Randomized; Randomized Controlled Trials; Recovery; Recruitment Activity; Research; Research Project Grants; Safety; Sampling; Schizophrenia; Self Efficacy; Self-Injurious Behavior; Series; Services; Severities; Statistical Models; Suicide; Suicide attempt; Suicide prevention; Symptoms; System; Telephone; Time; Triage; Vulnerable Populations; Walking; Work; base; brief intervention; clinically significant; coping; design; evidence base; follow-up; handheld mobile device; help-seeking behavior; high risk; insight; lifetime risk; mobile computing; novel; predictive modeling; programs; prospective; psychologic; relative effectiveness; satisfaction; scale up; severe mental illness; skills; suicidal behavior; suicidal morbidity; suicidal risk; suicide rate; symptom treatment; targeted treatment; therapy development; treatment adherence; urgent care

PROJECT SUMMARY/ABSTRACT Bipolar disorder and schizophrenia, both serious mental illnesses (SMIs), are present in up to one third of suicide deaths, and yet research is lacking on suicide-specific interventions in this large population. Walk-in urgent care clinics are a best practice in increasing access to mental health care for SMI, and many people with SMI who present to such clinics are at elevated risk for suicide. Yet, only 50% of patients who are referred from urgent care do not attend follow up outpatient appointments. Thus, walk-in clinics provide an important and novel setting in which to deploy suicide-specific interventions that bridge the transition from urgent to outpatient care. This intervention development research project evaluates the feasibility, acceptability, and preliminary impact of a brief cognitive behavioral intervention, tailored to SMI, that is delivered during the gap period between urgent care evaluation and follow-up outpatient care. SafeTy and Recovery Therapy (START) is a 4-session cognitive behavioral intervention augmented by mobile technology, which delivers automated and personalized reinforcement of adaptive coping behavior outside of the clinic setting. START builds from collaborative development alongside a community psychiatric service organization, and our preliminary data in the SMI population that supports the feasibility, acceptability, and impact of brief, mobile augmented cognitive behavioral intervention. Preliminary data also support the impact of mobile augmented CBT in enhancing treatment adherence and coping self-efficacy, along with providing novel insights on the near term dynamics of suicide-related exacerbations through intensive longitudinal data. In a 3- year developmental study, our deployment focused approach will first refine intervention procedures, safety and care continuity protocols, and fit with the deployment setting with a series of collaborative contacts with community providers, project staff, advisors, and patient advocates. We will next conduct a pilot randomized controlled trial with 70 patients diagnosed with either bipolar disorder or schizophrenia rapidly referred by community triage providers to receive START in the walk-in clinic setting. Patients are enrolled who have SMI diagnoses and current active suicidal ideation and/or a suicide attempt in the prior 3 months. Participants are randomized to one of two active conditions: START + Mobile augmentation or START alone. We will evaluate feasibility, acceptability, and enhancement of rates of outpatient treatment engagement and crisis service use in comparison to the sample population. We will also examine pragmatic mechanisms, which include outpatient treatment engagement and coping self-efficacy, on change in suicidal ideation severity and crisis service use along with the preliminary impact of mobile augmentation. Subsequent to this developmental research, the intervention developed here could be readily scaled to the wider network of walk-in clinics serving people with SMI in effort to reduce the high rate of suicide in this vulnerable population.

项目概要/摘要 双相情感障碍和精神分裂症都是严重的精神疾病 (SMI)，存在于多达三分之一的人中 自杀死亡，但缺乏针对这一庞大人群的针对自杀干预措施的研究。步入式 紧急护理诊所是增加 SMI 和许多人获得精神卫生保健机会的最佳做法 患有 SMI 的人到此类诊所就诊的自杀风险较高。然而，只有 50% 的患者 从紧急护理转介的患者不参加后续门诊预约。因此，步入式诊所提供了 重要而新颖的环境，可以在其中部署针对自杀的干预措施，以弥合从 紧急到门诊治疗。该干预开发研究项目评估了可行性， 针对 SMI 量身定制的简短认知行为干预的可接受性和初步影响，即 在紧急护理评估和后续门诊护理之间的间隙期间提供。安全和 恢复疗法 (START) 是一种通过移动技术增强的 4 个疗程的认知行为干预， 它在诊所外提供自动化和个性化的适应性应对行为强化 环境。 START 建立在与社区精神科服务组织合作开发的基础上， 以及我们在 SMI 人群中的初步数据，这些数据支持简短的可行性、可接受性和影响， 移动增强认知行为干预。初步数据也支持了移动设备的影响 增强 CBT 可以提高治疗依从性和应对自我效能，并提供新的 通过密集的纵向数据了解自杀相关恶化的近期动态。在 3- 年发展研究，我们以部署为重点的方法将首先完善干预程序、安全性 和护理连续性协议，并通过一系列协作联系来适应部署环境 社区提供者、项目工作人员、顾问和患者倡导者。接下来我们将进行随机试点 对 70 名被诊断患有双相情感障碍或精神分裂症的患者进行的对照试验迅速转介给 社区分诊提供者在步入式诊所环境中接受 START。入组患有 SMI 的患者 诊断和当前活跃的自杀意念和/或过去 3 个月内的自杀企图。参加者有 随机分配到两个活动条件之一：开始+移动增强或单独开始。我们将评估 门诊治疗参与率和危机服务使用率的可行性、可接受性和提高 与样本人群相比。我们还将研究务实机制，其中包括门诊 治疗参与度和应对自我效能，对自杀意念严重程度和危机服务使用变化的影响 以及移动增强的初步影响。在这项发展研究之后， 这里开发的干预措施可以很容易地扩展到更广泛的免预约诊所网络，为患有以下疾病的人提供服务 SMI 致力于降低这一弱势群体的高自杀率。