Brown Lily A, Webster Jessica L, Tran Jennifer T, Wolfe James R, Golinkoff Jesse, Patel Esha, Arcomano Amanda C, Ben Nathan Jennifer, Azat O'Connor Alexander, Zhu Yiqin, Oquendo Maria, Brown Gregory K, Mandell David, Mowery Danielle, Bauermeister José A
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States.
JMIR Res Protoc. 2023 Sep 29;12:e48177. doi: 10.2196/48177.
BACKGROUND: Suicide attempts and suicide death disproportionately affect sexual and gender minority emerging adults (age 18-24 years). However, suicide prevention strategies tailored for emerging adult sexual and gender minority (EA-SGM) groups are not widely available. The Safety Planning Intervention (SPI) has strong evidence for reducing the risk for suicide in the general population, but it is unclear how best to support EA-SGM groups in their use of a safety plan. Our intervention (Supporting Transitions to Adulthood and Reducing Suicide [STARS]) builds on content from an existing life skills mobile app for adolescent men who have sex with men (iREACH) and seeks to target core risk factors for suicide among EA-SGM groups, namely, positive affect, discrimination, and social disconnection. The mobile app is delivered to participants randomized to STARS alongside 6 peer mentoring sessions to support the use of the safety plan and other life skills from the app to ultimately reduce suicide risk. OBJECTIVE: We will pilot-test the combination of peer mentoring alongside an app-based intervention (STARS) designed to reduce suicidal ideation and behaviors. STARS will include suicide prevention content and will target positive affect, discrimination, and social support. After an in-person SPI with a clinician, STARS users can access content and activities to increase their intention to use SPI and overcome obstacles to its use. EA-SGM groups will be randomized to receive either SPI alone or STARS and will be assessed for 6 months. METHODS: Guided by the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework, we will recruit and enroll a racially and ethnically diverse sample of 60 EA-SGM individuals reporting past-month suicidal ideation. Using a type-1 effectiveness-implementation hybrid design, participants will be randomized to receive SPI (control arm) or to receive SPI alongside STARS (intervention arm). We will follow the participants for 6 months, with evaluations at 2, 4, and 6 months. Preliminary effectiveness outcomes (suicidal ideation and behavior) and hypothesized mechanisms of change (positive affect, coping with discrimination, and social support) will serve as our primary outcomes. Secondary outcomes include key implementation indicators, including participants' willingness and adoption of SPI and STARS and staff's experiences with delivering the program. RESULTS: Study activities began in September 2021 and are ongoing. The study was approved by the institutional review board of the University of Pennsylvania (protocol number 849500). Study recruitment began on October 14, 2022. CONCLUSIONS: This project will be among the first tailored, mobile-based interventions for EA-SGM groups at risk for suicide. This project is responsive to the documented gaps for this population: approaches that address chosen family, focus on a life-course perspective, web approaches, and focus on health equity and provision of additional services relevant to sexual and gender minority youth. TRIAL REGISTRATION: ClinicalTrials.gov NCT05018143; https://classic.clinicaltrials.gov/ct2/show/NCT05018143. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/48177.
背景:自杀未遂和自杀死亡对性少数和性别少数青年(18 - 24岁)的影响尤为严重。然而,专门针对性少数和性别少数青年群体(EA - SGM)的自杀预防策略并不普遍。安全计划干预(SPI)在降低普通人群自杀风险方面有充分证据,但目前尚不清楚如何最好地支持EA - SGM群体使用安全计划。我们的干预措施(支持向成年过渡并减少自杀[STARS])基于一款现有的针对男男性行为青少年的生活技能移动应用程序(iREACH)的内容构建,旨在针对EA - SGM群体自杀的核心风险因素,即积极情绪、歧视和社会脱节。移动应用程序会提供给随机分配到STARS组的参与者,同时还有6次同伴辅导课程,以支持安全计划的使用以及应用程序中其他生活技能的运用,最终降低自杀风险。 目的:我们将对同伴辅导与基于应用程序的干预措施(STARS)相结合进行试点测试,该干预旨在减少自杀意念和行为。STARS将包括自杀预防内容,并针对积极情绪、歧视和社会支持。在与临床医生进行面对面的SPI后,STARS用户可以访问相关内容和活动,以增强他们使用SPI的意愿并克服使用障碍。EA - SGM群体将被随机分配,分别单独接受SPI或接受STARS,并将进行为期6个月的评估。 方法:在RE-AIM(覆盖范围、效果、采用率、实施和维持)框架的指导下,我们将招募并纳入60名报告过去一个月有自杀意念的种族和族裔多样化的EA - SGM个体样本。采用类型1有效性 - 实施混合设计,参与者将被随机分配接受SPI(对照组)或接受SPI并同时接受STARS(干预组)。我们将对参与者进行6个月的随访,分别在第2、4和6个月进行评估。初步有效性结果(自杀意念和行为)以及假设的变化机制(积极情绪、应对歧视和社会支持)将作为我们的主要结果。次要结果包括关键实施指标,包括参与者对SPI和STARS的意愿和采用情况以及工作人员实施该项目的经验。 结果:研究活动于2021年9月开始,目前仍在进行中。该研究已获得宾夕法尼亚大学机构审查委员会的批准(协议编号849500)。研究招募于2022年10月14日开始。 结论:该项目将是首批专门为有自杀风险的EA - SGM群体量身定制的基于移动应用程序的干预措施之一。该项目回应了该人群中已记录的差距:涉及选择的家庭、关注生命历程视角、网络方法以及关注健康公平和提供与性少数和性别少数青年相关的额外服务的方法。 试验注册:ClinicalTrials.gov NCT05018143;https://classic.clinicaltrials.gov/ct2/show/NCT05018143。 国际注册报告识别码(IRRID):DERR1-10.2196/48177。
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