The three areas of the OCD research are as follows: Suicide Risk in the Medical Setting Suicide is an international public health threat. In the U.S., it is the 2nd leading cause of death for youth and the 10th leading cause of death for adults. As suicide risk screening becomes a national priority for medical settings, non-mental health clinicians require valid, psychometrically-sound screening instruments for assessing suicide risk. However, there are very few such mental health assessment instruments that have been validated empirically with medical patients in medical settings. Recognizing this gap early and capitalizing on clinical and research expertise within our group, we began with developing a risk of suicide screen for pediatric patients in the emergency room in 2008 which resulted in a validated tool, the ASQ (Ask Suicide Screening Questions). The ASQ has been translated into Spanish, French and Dutch and is currently being implemented in emergency departments in the US and abroad. The tool is available on the NIMH website at www.nimh.nih.gov/news/science-news/ask-suicide-screening-questions-asq.shtml for public use. Since the development of the ASQ, the focus of our ongoing suicide screening studies has been to develop and validate brief screening instruments that can be administered by non-mental health clinicians in other medical settings and with specific patient populations. We currently have 4 IRB-approved protocols addressing suicide screening in different medical settings (NCT00623493, NCT01517126, NCT02140177, NCT02050867). We are addressing areas of need, including pediatric and adult emergency department patients, and pediatric and adult medical inpatients. Our research is consistent with NIMH's commitment to join with the National Action Alliance for Suicide Prevention to reduce the suicide rate by 20% over the next 5 years. Psychiatric Aspects of HIV/AIDS In 2008 the NIH, led by NIAID, initiated a partnership with the District of Columbia (DC) government with the goal of reducing the impact of HIV on DC, which has almost a 3% prevalence rate of HIV infection, the highest of any city in the US. The program was also created to develop research infrastructure in the city to generate knowledge and change public policy as well as to develop research across NIH. In alignment with the NIMH's commitment to reduce the burden of mental illness in the HIV/AIDS population, NIMH, NINDS and NIAID have developed 2 intramural protocols (NCT01875588; NCT01692236) investigating HIV-related neurocognitive disorders, which are a clinical challenge and threat to the long-term health of people living with HIV/AIDS. In addition, we have worked to assess the mental health needs of HIV patients and build an interdisciplinary approach to HIV and mental health in DC, leading to several protocols being initiated at other DC institutions. HIV-related research activities in the OCD fall into three categories: 1) Mental Health Program of the DC-NIH Partnership for AIDS Progress (DC PFAP), 2) NIH Intramural NeuroHIV Program, and 3) Collaborations with multi-site research networks. Mental Health Aspects of Coping with Chronic Medical Illness Born out of our clinical work on the PCLS and neurocognitive assessment service for the past decade, a natural research focus has emerged from our collaborative work with other Institutes at NIH. For example, working with the Pediatric Oncology Branch we began to study distress and its correlates in medically ill children, particularly those with life-limiting illnesses, through 3 protocols over the past 5 years (NCT00824278, NCT00969579, NCT02423031). The collaboration has been highly productive leading to the development of the first advance care planning guide for adolescents and young adults with life-limiting illnesses, Voicing My CHOiCES www.agingwithdignity.org/forms/voicingmychoices.pdf. This planning guide is available at www.agingwithdignity.org Another study along these lines (NCT01778478) focuses on how to screen and diagnose psychiatric disorders in young adults (ages 18-25) with and without cancer. The study examines the feasibility of using the structured psychiatric diagnostic interview, K-SADS-PL in this age group and evaluates whether the parent interview affects diagnostic findings. In addition, the study assesses psychosocial developmental milestone acquisition among young adult cancer patients compared to their healthy peers.
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