Adaptive intervention to prevent adolescent suicidal behavior following psychiatric hospitalization: A Sequential Multiple Assignment Randomized Trial

预防青少年精神病住院后自杀行为的适应性干预：一项序贯多重分配随机试验

• 批准号: 10272610
• 负责人: Ewa Karina Czyz
• 金额: $ 73.43万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-07 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10272610
• 关键词: 17 year old; Acute; Address; Adolescent; Age; Area; Cause of Death; Cellular Phone; Continuity of Patient Care; Emergency department visit; Environment; Event; Feeling suicidal; Funding; Goals; Health behavior outcomes; Healthcare Systems; Hospitalization; Hospitalized Adolescent; Hospitals; Inpatients; Interruption; Intervention; Link; Mediating; Motivation; National Institute of Mental Health; Outcome; Parents; Phase; Procedures; Psychiatric therapeutic procedure; Public Health; Randomized; Recurrence; Research; Resources; Risk; Safety; Self Efficacy; Sequential Multiple Assignment Randomized Trial; Services; Severities; Suicide; Suicide attempt; Suicide prevention; Surveys; Technology; Teenagers; Testing; Text; Text Messaging; Time; United States; Youth; acceptability and feasibility; adaptive intervention; adolescent suicide; adverse outcome; base; comparative efficacy; coping; cost; design; effective intervention; high risk; hospital readmission; ideation; improved; innovation; inpatient service; mobile computing; motivational enhancement therapy; multi-component intervention; new technology; novel; novel strategies; personalized intervention; prevent; primary outcome; reducing suicide; response; secondary outcome; sex; suicidal; suicidal adolescent; suicidal behavior; suicidal risk; suicide rate; treatment response; treatment strategy; trial design

ABSTRACT The increasing rates of suicide among adolescents is an urgent public health concern. In parallel, emergency department (ED) visits and psychiatric hospitalizations due to youth suicide risk have also been on the rise. Although psychiatric hospitalization provides critical stabilization, discharged adolescents remain at elevated risk for recurrent suicidal crises (e.g., suicide attempts, rehospitalizations). New approaches are urgently needed to alter risk trajectories and prevent suicidal behavior among adolescents transitioning from inpatient care. Bridging an adaptive intervention (AI) strategy—wherein type, intensity, and timing of treatment can be individualized to address suicidal adolescents’ changing and heterogenous treatment needs—together with mobile technology to reach adolescents during the high-risk post-discharge period, our goal is to identify an optimal AI for reducing youth suicidal behavior after inpatient care. We build on promising evidence from our recently completed NIMH-funded pilot sequential multiple assignment randomized trial (SMART) of a multi- component intervention comprised of: a Motivational Interview (MI)-enhanced safety plan delivered to adolescents and parents during hospitalization (MI-SP); post-discharge booster calls provided to youth and parents; and text-based support (Texts) delivered to adolescents daily for a month after discharge. In addition to feasibility and acceptability, the pilot SMART results suggested that certain intervention sequences improved key mechanisms of change (self-efficacy, safety plan use, coping) and were, preliminarily, associated with lower suicidal behavior 3 months after discharge. In this application, we propose to conduct a full-scale SMART to address the following specific aims: (1) Compare the AIs that begin with MI-SP alone or MI-SP plus Texts on the primary outcome of suicidal behavior (actual, interrupted, or aborted attempts) within 3 months post discharge and the two secondary outcomes of time-to-suicidal behavior and severity of suicidal ideation over 6 months; and (2) Determine the optimal sequence of intervention components by comparing four AIs embedded in the SMART on primary and secondary outcomes. Adolescents (N=300), ages 13-17, hospitalized due to suicidal ideation and/or attempt will be initially randomized to MI-SP alone or MI-SP with Texts. Based on adolescents’ responses to daily surveys, those classified as non-responders within 2 weeks post discharge will be re-randomized to added low-intensity booster calls (one call with adolescent and one call with parent) or high-intensity boosters (six calls with each). Secondary aims are to: (1) Identify moderators of initial intervention options and of augmentation strategies for non-responders; and (2) Examine whether mechanisms of change (self-efficacy, safety plan use, coping) mediate the impact of MI-SP plus Texts and that of high- intensity boosters. The proposed research will have significant public health impact by testing different sequences of continuity of care strategies within an innovative SMART design to identify an optimal technology-augmented AI targeting suicidal behavior reduction among youth transitioning from inpatient care.

抽象的 青少年自杀率的提高是紧急的公共卫生问题。并行，紧急情况 部门（ED）访问和由于青年自杀风险而导致的精神病住院也在增加。 尽管精神病医院提供了关键的稳定，但出院的青少年仍处于升高状态 复发自杀危机的风险（例如，自杀企图，重新建立）。新方法急切 需要改变风险轨迹并防止青少年从住院过渡的青少年行为 关心。弥合适应性干预（AI）策略 - 治疗的类型，强度和时机可以是 个性化以满足自杀青少年的变化和异源治疗需求 - 移动技术在高风险的后收费期间接触青少年，我们的目标是确定 在住院护理后减少青年自杀行为的最佳AI。我们以我们的承诺证据为基础 最近完成了NIMH资助的飞行员顺序多次分配随机试验（SMART） 组件干预完成：励志面试（MI）增强安全计划已交付给 住院期间的青少年和父母（MI-SP）；提供给青年和 父母;和基于文本的支持（文本）每天在出院后一个月交付给青少年。此外 为了可行性和可接受性，飞行员智能结果表明某些干预序列有所改善 变化的关键机制（自我效能，安全计划使用，应对），并且是初步的 出院3个月后较低的自杀行为。在此应用程序中，我们建议进行全面进行 智能解决以下特定目标：（1）比较单独使用MI-SP或MI-SP Plus的AI 关于自杀行为的主要结果（实际，中断或中断尝试）的主要结果的文本 出院后以及自杀想法的杀害行为和严重程度的两个次要结果 超过6个月； （2）通过比较四个AIS来确定干预组件的最佳序列 嵌入了SMART中的主要和次要结果。青少年（n = 300），年龄13-17岁，住院 由于自杀和/或尝试，最初将单独将其随机分配给MI-SP或带有文本的MI-SP。基于 关于青少年对每日调查的反应，在出院后2周内被归类为非反应者 将重新融合以添加低强度助推器呼叫（一个带有青春期的呼叫，与父母打电话）或 高强度助推器（每个呼叫六个）。次要目的是：（1）确定初始的主持人 干预选择和非反应者的增强策略； （2）检查机制是否 变化（自我效能，安全计划使用，应对）介导Mi-Sp Plus文本的影响以及高度的影响 强度助推器。拟议的研究将通过测试不同的公共卫生影响重大影响 创新智能设计中护理策略连续性的序列，以确定最佳 以技术为目标的AI针对年轻人从住院护理过渡的自杀行为减少。