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.

滥用酒精与自杀危机（即急性自杀意念或企图）和死亡密切相关。 自杀危机（包括滥用酒精的人）的标准护理是急性精神科治疗 急性精神科住院治疗的重点是快速稳定病情和解决危机。 将高危患者转介至门诊治疗，让他们重新回到充满压力的环境中。 以情绪调节训练为基础的干预措施已被证明可以同时减少酒精摄入 然而，不到 50% 的精神病住院患者在门诊接受治疗。 治疗造成了护理方面的危险缺口；最近出院的人自杀风险最高； 这项以患者为导向的研究职业发展奖（K23） 涉及开发一种新型辅助干预措施，以 (1) 加强对高危精神病患者的标准护理 滥用酒精的住院患者，以及 (2) 创造持续康复的机会并降低酒精中毒的风险 此干预措施名为“移动医疗支持的技能”。 酒精和相关自杀训练（mSTARS），结合情绪调节技能训练 在紧急情况下通过移动医疗应用程序实施，旨在鼓励在紧急情况下使用这些技能 K23 的研究计划分为两个阶段： 开发（第一阶段：AIMS） 1 和 2）以及 mSTARS 的可行性和可接受性评估（第 2 阶段：AIM 3）。 开发中，我们将对自杀精神病患者进行为期 6 周的生态瞬时评估（EMA）研究 滥用酒精的住院患者 (N = 35) 来阐明饮酒的随时间变化的预测因素 自杀意念，并检查特定情绪调节缺陷的作用将有助于分析。 对应用程序进行调整，以根据经验实时提出情绪调节技能的建议 （目标 1） mSTARS，包括住院技能培训部分和 mHealth 应用程序，将得到迭代完善。 对有自杀倾向的精神病住院患者的两个连续队列（每组 n = 5）进行由患者驱动的修改 滥用酒精的人 (AIM 2) mSTARS 的最终版本将纳入 AIM 1 的调查结果。 在 AIM 3 的三组可行性/可接受性随机对照试验中进行评估，比较 mSTARS (n = 15) 仅住院技能培训 (n = 10) 和照常治疗 (TAU) (n = 10) 该 K23 的研究计划是 与 PI 的培训目标密切相关，即获得以下方面的经验：(1) 高级纵向建模 EMA 数据，(2) 移动医疗支持的治疗开发，以及 (3) 临床试验设计和管理。 在 5 年 K23 奖励期内，这些培训目标将促进 PI 成为一名 从 K23 开始，PI 研究计划的更广泛目标是 开发综合的、可扩展的和具有成本效益的移动医疗支持的干预措施来治疗并发酒精 整个治疗环境中的误用和自杀行为，降低了这一服务不足人群的风险。