Overview Abstract Suicide is the 2nd leading cause of death among adolescents and has increased by 20% in the past decade. The majority of suicide decedents have their last clinical contact in primary care. This ALACRITY Center proposes 3 studies designed to help PCPs capitalize on universal screening for teen depression by enhancing pediatric primary care?s capacity to identify, triage, and manage depressed and suicidal adolescents. To promote a consistent, best practice approach to adolescents who screen positive for depression or suicidality, Study 1 develops a decision support system (DSS) to guide PCPs? treatment recommendations to reflect patient acuity, barriers, attitudes, and treatment preferences. To increase the low rate of treatment attendance among patients who screen positive for depression, Study 2 develops and tests a personalized texting intervention that targets patient and parent motivation, readiness, and barriers. To guide PCPs upon identification of suicidal adolescents through routine screening, Study 3 develops and tests an app to guide the PCP to develop a safety plan and stabilize the suicidal patient, thereby avoiding unnecessary referrals to the ED and hospital. These studies are innovative through their use of technology to personalize interventions on the basis of personal preferences, motivations, barriers, and clinical presentation. These interventions are likely to be of high impact, by potentially doubling the rate of treatment adherence in depressed adolescents and halving the rate of suicide attempts in those at high risk. We will solicit pilot projects through innovation contests for teams of investigators and stakeholders on novel methods to identify and reduce suicidal risk in adolescents, such use of data mining of health records to identify suicidal youth, and assessment of suicide risk via analysis of speech and facial expression. These studies will be conducted in our CTSI-supported pediatric research practice network, PittNet, which has successfully supported many mental health research studies. PittNet facilitated meetings with pediatricians and other stakeholders to collaboratively develop these priorities and associated studies, so that the ensuing products would be meaningful, practical, useful to clinicians and patients, and highly likely to be disseminated. This Center provides shared infrastructure for the engagement and collaboration with stakeholders, as well as for recruitment, assessment, technology development, data management and analysis, access to EHRs and costs analyses. Our multidisciplinary team of primary care and mental health professionals, data scientists, and health services researchers has collectively led 9 NIH funded trials of mental health interventions in primary care, 10 NIMH-funded intervention development or clinical trials for mood disordered and suicidal adolescents, and 7 NIH grants that develop and test technologies to support clinicians and patients. This team has extensive experience collaborating with stakeholders, managing research centers, and training early career scientists and forges a collaborative network dedicated to the reduction of youth suicide risk in pediatric primary care.
Suicide is the 2nd leading cause of death, but depressed and suicidal youth, who are at high risk for suicide, are often not identified, and when identified, do not go for treatment. Pediatric primary care is an ideal place to identify youth at risk for suicide because at-risk youth are much more likely to present in primary care than in specialty mental health care, and because it has become increasing routine to screen for depression and suicidal ideation during adolescent well visits. This Center, ETUDES (Enhancing Treatment Utilization for Depression and Emergent Suicidality) will use technology to reduce the public health burden of adolescent depression and suicidal ideation by enhancing the capacity of pediatric to accurately identify those patients in need of treatment, to improve the likelihood that youth referred for treatment will actually engage in treatment, and to guide PCPs in best practice for the stabilization of acutely suicidal adolescents.
