Development of mHealth-Supported Skills Training for Alcohol and Related Suicidality (mSTARS): Emotion Regulation Skills Training to Enhance Acute Psychiatric Care and Recovery

开发移动医疗支持的酒精和相关自杀技能培训 (mSTARS)：情绪调节技能培训，以加强急性精神科护理和康复

• 批准号: 10721452
• 负责人: Jeremy Grove
• 金额: $ 16.83万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10721452
• 关键词: Acute; Address; Admission activity; Adult; Alcohol consumption; Alcohols; Ambulatory Care; Area; Back; Behavior; Behavior Therapy; Behavioral; Caring; Cessation of life; Client satisfaction; Clinical; Clinical Trials; Clinical Trials Design; Cognitive; Coupled; Dangerousness; Data; Development; Ecological momentary assessment; Educational Intervention; Emotions; Environment; Evaluation; Feedback; Feeling suicidal; Goals; Health Services Accessibility; Heavy Drinking; Hospitalization; Individual; Inpatients; Intervention; Life; Long-Term Care; Mentored Patient-Oriented Research Career Development Award; Mentors; Methodology; Mobile Health Application; Modeling; Modification; National Institute of Mental Health; National Institute on Alcohol Abuse and Alcoholism; Outcome; Outpatients; Participant; Patient Discharge; Patients; Persons; Phase; Prevalence; Protocols documentation; Psychiatric therapeutic procedure; Public Health; Randomized; Randomized, Controlled Trials; Recommendation; Recovery; Reporting; Research; Research Personnel; Resolution; Risk; Risk Factors; Risk Reduction; Role; Societies; Statistical Models; Stress; Suicide; Suicide attempt; Suicide prevention; Time; Training; Treatment Efficacy; Underserved Population; acceptability and feasibility; acute care; alcohol misuse; alcohol related consequences; arm; care seeking; career; cohort; cost; cost effective; design; emotion regulation; experience; follow-up; high risk; high risk population; hospital readmission; innovation; inpatient service; mHealth; novel; novel strategies; primary outcome; programs; public health priorities; recruit; secondary outcome; skills; skills training; standard care; suicidal; suicidal behavior; suicidal risk; suicide rate; sustained recovery; therapy development; tool; treatment as usual; trial comparing

Alcohol misuse is strongly associated with suicide crises (i.e., acute suicidal ideation or attempts) and death. The standard care for a suicide crisis, including for persons who misuse alcohol, is acute psychiatric hospitalization. Acute psychiatric hospitalization focuses on stabilization and crisis resolution prior to quickly discharging at-risk patients back into their stressful environments with a referral for outpatient care. Outpatient- based interventions focused on emotion regulation training have been shown to simultaneously reduce alcohol misuse and suicidal behavior. Yet, less than 50% of psychiatric inpatients follow through with outpatient treatment, which creates a dangerous gap in care; risk for suicide is the highest among recently discharging patients who misuse alcohol. This Mentored Patient-Oriented Research Career Development Award (K23) involves the development of a novel adjunctive intervention to (1) enhance standard care for at-risk psychiatric inpatients who misuse alcohol, and (2) create an opportunity for sustained recovery and reduced risk for a subsequent suicide crisis during the post-discharge period. This intervention, entitled mHealth-supported Skills Training for Alcohol and Related Suicidality (mSTARS), combines emotion regulation skills training implemented in the acute setting with a mHealth app designed to encourage utilization of these skills during the risky post-discharge period. The research plan for this K23 has two phases: development (Phase 1: AIMS 1 and 2) and evaluation of feasibility and acceptability of mSTARS (Phase 2: AIM 3). To inform mHealth app development, we will conduct a 6-week ecological momentary assessment (EMA) study on suicidal psychiatric inpatients who misuse alcohol (N = 35) to elucidate time-varying predictors for alcohol consumption and suicidal ideation, and examine the role of specific emotion regulation deficits. Analyses will facilitate adjustments to the app to make empirically-based recommendations for emotion regulation skills in real time (AIM 1). mSTARS, including the inpatient skills training component and mHealth app, will be iteratively refined per patient-driven modifications over two successive cohorts (n = 5 in each) of suicidal psychiatric inpatients who misuse alcohol (AIM 2). The finalized version of mSTARS, while incorporating AIM 1 findings, will be evaluated in AIM 3 in a three-arm feasibility/acceptability randomized control trial comparing mSTARS (n = 15) to inpatient skills training (n = 10) and treatment as usual (TAU) only (n = 10). The research plan for this K23 is closely tied to the PI’s training goals, which are to gain experience with (1) advanced longitudinal modeling of EMA data, (2) mHealth-supported treatment development, and (3) clinical trials design and management. Over the 5-year K23 award period, these training goals will facilitate the PI’s overarching career goal of becoming an independent clinical researcher. Beginning with this K23, the broader aim of the PI’s research program is to develop integrated, scalable, and cost-effective mHealth-supported interventions to treat concurrent alcohol misuse and suicidal behavior across treatment settings, reducing risk for this underserved population.

酗酒与自杀危机（即急性自杀的想法或企图）和死亡密切相关。 自杀危机的标准护理，包括小姐酒精的人，是急性精神病学的 住院。急性精神病医院的重点是稳定和危机解决方案 通过转诊以进行门诊护理，将高危患者送回压力环境。门诊 已经证明，针对情绪调节训练的基于重点的干预措施同时减少酒精 滥用和自杀行为。然而，不到50％ 治疗，这会在护理中造成危险的差距；自杀的风险是最近出院的最高风险 错过酒精的患者。这项指导的面向患者的研究职业发展奖（K23） 涉及开发新颖的辅助干预措施以（1）增强高危精神病的标准护理 错过酒精的住院患者，（2）为持续康复和降低风险的机会创造了机会 随后的自杀危机期间的自杀危机。这种干预措施，名为MHealth支持的技能 酒精和相关自杀培训（MSTARS）结合了情感调节技能培训 通过MHealth应用程序在急性环境中实施，旨在鼓励在 危险的后收费期。该K23的研究计划有两个阶段：开发（第1阶段：目的 1和2）以及MSTAR的可行性和可接受性的评估（第2阶段：目标3）。通知MHealth应用程序 开发，我们将对自杀精神病学的为期6周的生态瞬时评估（EMA）研究 错过酒精（n = 35）的住院患者，以阐明饮酒和饮酒的时间变化预测因子 自杀思想，并检查特定情绪调节的作用定义。分析将有助于 调整该应用程序以实时对情绪调节技能提出基于经验的建议 （目标1）。 MSTAR，包括住院技能培训组件和MHealth应用程序，将进行迭代精制 自杀精神病患者的两个成功队列（n = 5）的每个患者驱动的修改 谁滥用酒精（AIM 2）。最终版本的MSTARS在编码AIM 1发现时将是 在比较MSTAR的三臂可行性/可接受性随机对照试验中，在AIM 3中进行了评估（n = 15） 进行住院技能培训（n = 10）和像往常一样（tau）（n = 10）。该K23的研究计划是 与PI的培训目标紧密相关，该目标是获得（1）高级纵向建模的经验 EMA数据，（2）MHealth支持的治疗开发，以及（3）临床试验设计和管理。超过 这些培训目标是5年的K23奖项期，将有助于PI的总体职业目标 独立的临床研究人员。从这个K23开始，PI研究计划的更广泛目的是 开发综合，可扩展和成本效益的MHealth支持的干预措施来治疗同时酒精 跨治疗环境的滥用和自杀行为，降低了这一服务不足的人群的风险。