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 岁青少年的第二大死因。然而，大多数自杀高危青少年都未被识别和治疗，对于一半的青少年自杀者来说，第一次自杀尝试是致命的 为了提高对自杀高危青少年的识别，回应 RFA-MH-14-070，《儿童自杀》在急诊科的预防方面，我们提议与儿科紧急护理应用研究网络 (PECARN) 和怀特河 PHS 印度医院开展一个多站点合作项目。这些急诊室为不同地域和社会人口的青年群体提供服务，其中包括自杀风险特别高的美洲印第安人青年。在研究 1 中，我们将使用广泛的风险因素对 6743 名 12 至 17 岁的青少年进行普遍自杀风险评估，这些青少年在随机选择的筛查轮班期间到 14 个急诊科 (ED) 之一就诊。我们将在 3 个月和 6 个月时对这些青少年中 30% 的子样本进行随访，并丰富自杀风险因素。我们的具体目标是：（1）开发计算机自适应屏幕（CAS）来预测自杀企图； (2) 将 CAS 的心理测量特性（例如，敏感性、特异性）与标准筛查、询问自杀筛查问题 (ASQ) 的心理测量特性进行比较； (3) 测试内隐联想测试（IAT）的能力，这是一种内隐自杀认知的行为测试，以增量方式添加预测 自杀企图超出筛查分数； (4) 开发并验证基于 CAS 的简约风险分层算法，以方便对青少年进行分类。在研究 2 中，我们将招募 2340 名青少年的新样本（按自杀风险因素分层），对 CAS 和 ASQ 进行管理，并在 3 个月内对青少年进行访谈和医疗图表审查。我们的研究 2 的目的是验证 CAS 和 ASQ 在预测自杀企图方面的特异性和敏感性。该合作项目开发的最佳筛查将有可能在全国范围内传播，以增强急诊部门识别和有效分类处于自杀未遂严重风险的青少年的能力。该项目意义重大，因为在医疗机构中对高危青少年进行筛查和分类是国家自杀预防战略减少青少年自杀的关键战略。它具有高度创新性，因为它将开发和测试计算机化自适应筛选（CAS），从而根据之前的回答生成个性化的筛选问题序列；它将测试一系列广泛的急性自杀风险指标，以便将其纳入 CAS 中。此外，该项目将测试 IAT 的增量价值，这很重要，因为许多高危青少年可能会否认自杀念头。鉴于 PECARN 强大的基础设施和成功招募记录，以及调查团队在多地点研究、计算机自适应测试和急诊室青少年自杀研究方面的集体经验，该项目是可行的。