Background. Suicide is the second leading cause of death among 15-24 year olds in the United States, yet there is a dearth of evidence-based prevention programs that explicitly address suicide risk factors prior to the onset of suicide attempts. First and second generation immigrant youth comprise 25% of the U.S. population under 18 and experience specific risk factors for suicidal ideation and attempts. This includes family conflict exacerbated by differing cultural expectations between parents and children and disruptions to parent-child communication. At the same time, family-based preventive interventions focused on enhancing family protective factors show promise for reducing later suicide risk. Research Strategy. The present study focuses on developing and testing a family-based preventive intervention for suicide risk through three interrelated projects. These are: 1) Conducting longitudinal analyses of two existing datasets to identify how social support assets (e.g., experiences of family, peer, and community support) buffer suicide risk for adolescents at high risk of suicidal behavior, and examining how these associations may vary by gender and racial/ethnic group; 2) Utilizing intervention mapping and qualitative data to develop and refine a new preventive intervention, the Early Intervention for Suicide Risk among Immigrant Youth; and 3) Pilot testing the early intervention with first and second generation immigrant Latino/a adolescents screening positive for suicide risk and their families. 40 families will be randomized to the intervention or to usual care. Feasibility, acceptability, and impact on the intervention targets will be assessed. Training Plan. In coordination with the research plan, Dr. Alvarez will pursue training in the following three areas: 1) methodological approaches relevant to development and evaluation of preventive interventions targeting low base rate behaviors; 2) innovative approaches to assessment of suicide risk in clinical research contexts; and 3) design and testing of prevention programs delivered in healthcare, school, and community settings, with a particular focus on suicide prevention. Her research will be based at the Disparities Research Unit in Massachusetts General Hospital, a Harvard Medical School affiliated, major medical center providing access to an abundance of clinical research resources and training opportunities. Mentorship. The project?s mentorship team provides a range of complementary expertise relevant to the research and training aims of this proposal. Dr. Alvarez?s primary mentor, Dr. Alegria, is an expert in health disparities and health services research with extensive experience in mentoring early career investigators, including K awardees. Her co-mentor Dr. Wyman provides expertise in youth suicide prevention and prevention research, and co-mentor Dr. Shrout provides expertise in statistical modeling of longitudinal data and analysis of clinical trial outcomes. A team of advisors provides additional expertise in the epidemiology of depression and suicidal behaviors (Dr. Roberts), adaptive testing for mental health assessment (Dr. Gibbons), family-based preventive intervention design and evaluation (Dr. Pantin), and clinical trials for depression and related disorders (Dr. Alpert). Candidate. Dr. Alvarez is an early career researcher trained in school and child clinical psychology who is completing NIMH-funded postdoctoral training in health disparities and mental health services research focused on culturally diverse populations. This K23 project would provide the foundation to launch her career as a clinical researcher specializing in suicide prevention, with a particular focus on interventions addressing the needs of immigrant youth and on family-based preventive interventions delivered in healthcare and community settings.

Public Health Relevance

Suicide is the second-leading cause of death among adolescents, with rates increasing between 1999 and 2014. Family-based preventive interventions demonstrate promise for reducing suicide risk among adolescents, and are particularly relevant for addressing suicide risk factors specific to immigrant youth, who comprise one-fourth of the U.S. population under 18. The development of an effective preventive intervention for the immigrant youth population would make critical contributions to the reduction of suicide rates nationwide.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Mentored Patient-Oriented Research Career Development Award (K23)
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Mental Health Services Research Committee (SERV)
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Hill, Lauren D
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Massachusetts General Hospital
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Alvarez, Kiara; Fillbrunn, Mirko; Green, Jennifer Greif et al. (2018) Race/ethnicity, nativity, and lifetime risk of mental disorders in US adults. Soc Psychiatry Psychiatr Epidemiol :
Alegría, Margarita; NeMoyer, Amanda; Falgàs Bagué, Irene et al. (2018) Social Determinants of Mental Health: Where We Are and Where We Need to Go. Curr Psychiatry Rep 20:95