Emergency Department Screen for Teens at Risk for Suicide (ED-STARS)

针对有自杀风险的青少年的急诊室筛查 (ED-STARS)

• 批准号: 9142376
• 负责人: David A. Brent
• 金额: $ 259.52万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-12 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9142376
• 关键词: Accident and Emergency department; Acute; Adolescent; Age; Aggressive behavior; Alcohol consumption; Alcohols; Algorithms; American Indians; Anxiety; Applied Research; Cause of Death; Childhood; Cognition; Cost Savings; Data; Drug usage; Emergency Care; Emergency department screening; Emergency department visit; Ethnic Origin; Feeling suicidal; Health; Healthcare; Healthy People 2020; Hospitals; Implicit Association Test; Impulsive Behavior; Interview; Measures; Medical; Medical emergency; Mental Depression; Mental Health; Parents; Patient Self-Report; Performance; Predictive Value; Probability; Property; Psychometrics; Race; Recommendation; Recording of previous events; Recruitment Activity; Reporting; Research; Research Infrastructure; Risk; Risk Assessment; Risk Factors; Role; Sampling; Self-Injurious Behavior; Sensitivity and Specificity; Site; Sleeplessness; Stratification; Subgroup; Substance abuse problem; Suicide; Suicide attempt; Suicide prevention; Surveys; Teenagers; Telephone Interviews; Testing; Triage; United States; Youth; base; behavior test; computerized; cost; experience; follow-up; high risk; improved; innovation; personalized screening; reducing suicide; response; screening; sex; suicidal; suicidal behavior; suicidal risk; treatment adherence

DESCRIPTION (provided by applicant): Suicide is the 2nd leading cause of death among youth ages 12 to 17 in the United States. However, most youth at high risk for suicide go unrecognized and untreated, and for half of adolescent suicides, the first suicide attempt is fatal To improve identification of youth at risk for suicide, in response to RFA-MH-14-070, Pediatric Suicide Prevention in Emergency Departments, we propose a multi-site collaborative project with the Pediatric Emergency Care Applied Research Network (PECARN) and the Whiteriver PHS Indian Hospital. These EDs serve geographically and socio-demographically diverse groups of youth, including American Indian youth who are at particularly high risk for suicide. In Study 1, we will implement a universal suicide risk assessment using a broad range of risk factors with 6743 youth, ages 12 to 17 years, who present to one of 14 emergency departments (EDs) during randomly chosen screening shifts. We will follow-up a subsample of 30% of these youth, enriched for suicide risk factors, at 3 and 6 months. Our specific aims are to: (1) develop a computerized adaptive screen (CAS) for predicting suicide attempts; (2) compare the psychometric properties (e.g., sensitivity, specificity) of the CAS to those of a standard screen, the Ask Suicide-Screening Questions (ASQ); (3) test the ability of the Implicit Association Test (IAT), a behavioral test of implicit suicidal cognitions, to add incrementally to the prediction of suicide attempts above and beyond screening scores; and (4) develop and validate a parsimonious CAS-based algorithm for risk stratification to facilitate the triage of youths. In Study 2, we will recruit a new sample of 2340 youth (stratified by suicide risk factors), administe the CAS and ASQ, and follow-up youth at 3-months with interviews and medical chart reviews. Our Study 2 aim is to validate the specificity and sensitivity of the CAS and ASQ for predicting suicide attempts. The optimal screen developed in this collaborative project will have the potential to be disseminated nationwide to enhance the capacity of emergency departments to identify and effectively triage youth at acute risk for suicide attempts. This project is significat because the screening and triage of at-risk youth in healthcare settings are key strategies of the National Strategy for Suicide Prevention to reduce adolescent suicide. It is highly innovative because it will develop and test a computerized adaptive screen (CAS), which results in individualized sequences of screening questions conditional on previous responses; and it will test a wide range of acute suicide risk indicators for possible inclusion in the CAS. In addition, this project will test the incremental value of the IAT, which is important as many at-risk youth may deny suicidal thoughts. This project is feasible given PECARN's strong infrastructure and record of successful recruitment, and the investigative team's collective experience in multi-site studies, computerized adaptive testing, and youth suicide research in ED settings.

描述（由申请人提供）：自杀是美国12至17岁的青年中的第二大死亡原因。但是，大多数有自杀风险高风险的年轻人未被识别和未经治疗，对于一半的青少年自杀，首次自杀企图是致命的，以改善对自杀风险的年轻人的识别，以应对RFA-MH-14-070，以应对RFA-MH-14-070，以对急诊室进行急诊式研究（我们建议使用PEDIATICERATION PARTIEN）（我们建议使用PEDIAD SITE）（我们建议使用PEDIAD SITE） Whiteriver PHS印度医院。这些ED在地理和社会学上多样化的青年群体，包括自杀风险特别高的美洲印度青年。在研究1中，我们将使用6743名年轻人（12至17岁的年轻人）进行普遍的自杀风险评估，他们在随机选择的筛查转移期间向14个急诊科（EDS）之一提出。我们将在3个月和6个月的时间里跟进这些年轻人的30％的子样本，富含自杀危险因素。我们的具体目的是：（1）开发用于预测自杀尝试的计算机化自适应屏幕（CAS）； （2）将CAS的心理测量特性（例如，灵敏度，特异性）与标准屏幕的心理测量特性（询问自杀筛查问题（ASQ））进行比较； （3）测试隐式结合测试（IAT）的能力，即隐式自杀认知的行为测试，以逐步增加预测 自杀企图超越筛查得分； （4）开发和验证一种基于CAS的简约算法，以促进年轻人分类的风险分层。在研究2中，我们将招募2340名青年的新样本（由自杀危险因素分层），管理CAS和ASQ，以及在3个月的访谈和医疗图表审查的3个月以来的后续青年。我们的研究2的目的是验证CAS和ASQ的特异性和敏感性，以预测自杀尝试。在此协作项目中开发的最佳屏幕将有可能在全国范围内传播，以增强急诊室的能力，以确定并有效地识别和有效地分类年轻人以自杀企图的急性风险。该项目很重要，因为在医疗保健环境中对高危青年的筛查和分类是国家预防自杀策略以减少青少年自杀的关键策略。它具有很高的创新性，因为它将开发和测试计算机化的自适应屏幕（CAS），从而导致筛选问题的个性化序列以先前的回答为条件；它将测试广泛的急性自杀风险指标，以便将其纳入CAS。此外，该项目将测试IAT的增量价值，这很重要，因为许多处于危险的年轻人可能否认自杀思想。鉴于Pecarn的强大基础设施和成功招聘的记录以及调查团队在多站点研究，计算机化自适应测试以及ED环境中的青年自杀研究方面的集体经验，该项目是可行的。