Suicide Prevention with Substance Using Youth Experiencing Homelessness

通过使用无家可归青少年的药物来预防自杀

基本信息

批准号：
10712445
负责人：
NATASHA SLESNICK
金额：
$ 78.28万
依托单位：
OHIO STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-01 至 2028-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10712445
关键词：
Address Adopted Adoption Advocacy Affect Cause of Death Cessation of life Cognitive Cognitive Therapy Communities Community Services Complement Dangerousness Data Dehumanization Drops Exclusion Feasibility Studies Feeling suicidal Future Goals Health Services Accessibility Homelessness Hospitalization Individual Intervention Intervention Studies Knowledge Literature Mediating Mediator Mental Health Mental disorders Methods Modeling Outcome Outcome Study Pilot Projects Premature Mortality Race Randomized Reporting Research Resources Risk Factors Risk Reduction Sampling Services Sex Orientation Shelter facility Stress Suicide Suicide attempt Suicide prevention System Testing Theoretical model Therapeutic Intervention Time Victimization Vulnerable Populations Youth adolescent substance use completed suicide cost depressive symptoms dosage effective intervention evidence base experience follow up assessment follow-up health disparity human capital improved individual response marginalization outreach physical conditioning poor health outcome premature prevent prevention service preventive intervention primary outcome protective factors recruit reducing suicide secondary outcome services as usual sex social social exclusion substance use suicidal risk theories treatment effect uptake

项目摘要

Project Summary/Abstract While research on substance using youth experiencing homelessness (YEH) is increasing, there is a dearth of information regarding effective prevention interventions for these youth. This is of significant concern because studies indicate that 66% to 89% of YEH have a mental health disorder (Cauce et al., 2004) and 68% report at least one suicide attempt (Gewitz et al., 2020). In fact, suicide is the leading cause of death among YEH (Rotheram-Borus & Milburn, 2004; Yoder et al., 2010). Among those who have attempted suicide, an average of 6.2 attempts is reported, and lifetime suicidal ideation rates range from 14% to 66.5% (Yoder et al., 2010) with no clear evidence of effective interventions for YEH. This study uses general cognitive theory (Beck, 1967), complemented with concepts from two suicide specific theoretical models, to guide our intervention and conceptual change model. Our goal is to test strategies to extend delivery and uptake of a cognitive therapy intervention for YEH. Prior studies focus on service-connected youth, but research suggests that most street living YEH do not access services meant to assist them (Kelly & Caputo, 2007). We overcome prior sampling limitations through engaging service-disconnected youth in addition to service-connected youth through a local drop-in center. As such, three hundred substance using YEH with recent suicidal ideation or a recent suicide attempt will be randomly assigned to Cognitive Therapy for Suicide Prevention (CTSP) + Services as Usual (SAU) (N=150) or to SAU alone (N=150). CTSP has previously shown efficacy for YEH through a RCT pilot feasibility study (Slesnick et al., 2020; Wu et al., 2020). SAU includes outreach, advocacy and service linkage which are typical services offered by agencies serving those experiencing homelessness (Ober et al., 2012). Follow-up assessments will be conducted at 3, 6, 9 and 12-months post-baseline. It is hypothesized that youth receiving CTSP+SAU will show greater reductions in suicidal ideation (primary outcome), substance use and depressive symptoms (secondary outcomes) over time compared to SAU alone, as well as improved risk and protective factors. Theoretically-derived mediators will be tested to shed light on mechanisms associated with change, and the moderating effects of sex, race, sexual orientation and baseline service connection will be examined. In order to ease future dissemination of the intervention to agencies serving YEH, we will rigorously assess acceptability, feasibility, fidelity and cost associated with the delivery of our intervention approach using a mixed-methods approach. Ultimately, the goal of this research is to provide support for the use of a suicide prevention intervention for substance using YEH that reduces premature mortality, hospitalization, and loss of human capital and which can be easily adopted by agencies serving YEH.

项目概要/摘要虽然对无家可归青少年 (YEH) 使用药物的研究不断增加，但仍缺乏有关针对这些青少年的有效预防干预措施的信息。这是一个值得关注的问题，因为研究表明，66% 至 89% 的 YEH 患有精神健康障碍（Cauce 等人，2004 年），68% 的人报告称至少一次自杀未遂（Gewitz 等人，2020）。事实上，自杀是 YEH 的首要死因（Rotheram-Borus 和 Milburn，2004 年；Yoder 等人，2010 年）。在那些试图自杀的人中，平均据报告，自杀尝试次数为 6.2 次，终生自杀意念发生率范围为 14% 至 66.5%（Yoder 等，2010）没有明确的证据表明对 YEH 进行有效干预。本研究使用一般认知理论（Beck， 1967），补充了两个自杀特定理论模型的概念，以指导我们的干预和概念变革模型。我们的目标是测试延长认知疗法的实施和接受的策略对 YEH 的干预。之前的研究主要集中在与服务相关的年轻人，但研究表明大多数街头活着的 YEH 无法获得旨在帮助他们的服务（Kelly & Caputo，2007）。我们克服了先前的采样通过让与服务脱节的青年以及通过当地服务与服务相关的青年参与来消除局限性落入中心。因此，有 300 种使用 YEH 的物质最近有自杀意念或最近有自杀倾向自杀未遂将被随机分配至预防自杀认知疗法 (CTSP) + 服务通常 (SAU) (N=150) 或单独 SAU (N=150)。 CTSP 之前已通过一项研究显示了对 YEH 的功效 RCT 试点可行性研究（Slesnick 等人，2020 年；Wu 等人，2020 年）。 SAU 包括外展、宣传和服务链接，这是为无家可归者提供服务的机构提供的典型服务（Ober 等人，2012）。后续评估将在基线后 3、6、9 和 12 个月进行。这是假设接受 CTSP+SAU 的青少年自杀意念会显着减少（主要与单独 SAU 相比，随着时间的推移，物质使用和抑郁症状（次要结果），以及改善的风险和保护因素。理论上衍生的介体将被测试以揭示与变化相关的机制，以及性别、种族、性取向和基线的调节作用将检查服务连接。为了便于将来向各机构传播干预措施为 YEH 服务，我们将严格评估与交付相关的可接受性、可行性、保真度和成本我们的干预方法采用混合方法。最终，这项研究的目标是提供支持对使用 YEH 的物质进行自杀预防干预，以减少过早死亡死亡率、住院治疗和人力资本损失，这些数据可以很容易地被为 YEH 服务的机构采用。