Cheryl L. King, Ph.D. - US grants

DESCRIPTION (provided by applicant): In this application for a Mid-Career Investigator Award, Cheryl King, Ph.D., requests support for mentorship of early career investigators, advanced training, and new research focused on developing health behavior interventions for youth at risk for suicide. As emphasized in the Surgeon General's Call to Action to Prevent Suicide (1999) and the National Strategy for Suicide Prevention (2001), the development of evidence-based interventions for suicidal individuals is of substantial public health significance. The mentorship plan for early career investigators includes close integration and involvement with the candidate's research program, individualized goals and development of independent research projects, and consultation with nationally recognized senior investigators. The candidate's mentees will obtain substantial training in research with suicidal youth, health behavior theories and interventions, research ethics with high risk and vulnerable populations, and the development of culturally sensitive interventions. Current mentees include three junior faculty, one advanced child psychiatry fellow, 1 postdoctoral fellow, one senior research associate, and two graduate students. The candidate's career development plan proposes consultation and focused training in three areas related to the goal of developing interventions that promote treatment seeking, treatment adherence, and improved outcomes among youth at risk for suicide: (1) health behavior theories, social network models, and effective health behavior interventions for youth with chronic diseases and other at risk conditions;(2) culturally sensitive strategies for studying and implementing health behavior interventions;and (3) strategies for ensuring that study design, informed consent, and risk management procedures meet the highest ethical standards and changing regulatory requirements. A research plan is proposed that includes (1) continued intervention research related to the Youth-Nominated Support Team intervention for suicidal adolescents, and (2) development of a multi-component Emergency Department based health behavior intervention for adolescents at risk for suicide. This award will contribute substantially to the candidate's career objectives by relieving her of patient care duties and providing protected time for mentorship and advanced training activities.

DESCRIPTION (provided by applicant): Suicidal behavior is a significant concern on college campuses and suicide is the third leading cause of death in the U.S. college-aged population. Consistent with recommendations in the National Strategy for Suicide Prevention (2001) and spearheaded by organizations such as the American Foundation for Suicide Prevention, several universities have initiated voluntary web- based screening to identify students at elevated risk for suicide and in need of mental health services. This is a promising direction;however, research is needed to determine how to most effectively link students with positive screens to professional services. We propose to develop and pilot test a theoretically-driven intervention, Students'e-Bridge to Treatment (e-Bridge), which aims to identify students with elevated levels of known suicide risk factors and facilitate these students'linkage to mental health services. e-Bridge will incorporate motivational interviewing principles and draw from health behavior promotion models. Our initial aim is (1) to develop the e-Bridge intervention for students at risk for suicidal behavior due to depression and alcohol/substance misuse, or suicidal thoughts or behavior. e-Bridge will include (a) a web- based screen using standardized instruments to identify students at elevated suicide risk;(b) personalized feedback;and (c) the opportunity to correspond online with a professional who has been trained in motivational interviewing and is knowledgeable about local resources. This is consistent with a model emphasizing autonomy and self-determination. Additional aims are (2) to conduct a pilot feasibility study with a small number of college students at elevated risk, and (3) to conduct a pilot randomized controlled trial comparing e-Bridge to a control condition (personalized feedback and list of mental health resources). The primary quantitative outcome, assessed two months after screening, will be linkage to mental health services. Qualitative data will be collected about what students found to be most and least helpful about each intervention component. Secondary outcomes will include: a) suicidal thoughts and behavior;b) depression severity and alcohol/substance misuse;and c) the costs of the intervention. If the intervention is shown to be promising and then demonstrated to be effective in larger studies, it could prevent suicides and other adverse consequences among college adults nationwide. Suicide is a leading cause of death among young adults. Moreover, recent national surveys indicate that 10% of college students have seriously considered attempting suicide within the past year. In keeping with recommendations in the National Strategy for Suicide Prevention (2001), this project will develop and pilot test Students'e-Bridge to Treatment. This intervention will identify students at elevated risk for suicidal behavior and facilitate their linkage to appropriate treatments.

DESCRIPTION (provided by applicant): Suicidal behavior is highly prevalent among adolescents in the United States and associated with substantial morbidity. Moreover, suicidal behavior is a primary risk factor for suicide, which is the third leading cause of death for this age group. Despite the public health significance of suicidal behavior and suicide, few evidence-based prevention strategies have been developed for adolescents and even fewer have focused on preventing the initial occurrence of suicidal behavior. In response to RFA- CE-10-006 "Prevention of Suicidal Behavior through the Enhancement of Connectedness," this application proposes to rigorously assess the effectiveness of Links to Enhancing Teens'Connectedness (LET's CONNECT) in a randomized controlled prevention trial. LET's CONNECT was designed for adolescents who are at elevated risk for suicidal behavior due to low interpersonal connectedness, a recent history of bullying others, and/or a recent history of being bullied. It teams the adolescent with an adolescent-nominated "natural" mentor and a community mentor to actively facilitate and support the adolescent's engagement with community organizations and activities. Specific aims are to determine if adolescents in the LET's CONNECT condition relative to adolescents in the control condition (community resource information only): (1) report greater improvement in individual connectedness and community connectedness, and (2) are less likely to engage in suicidal behavior. PUBLIC HEALTH RELEVANCE: Despite the high prevalence of suicidal behavior among adolescents and the too frequent tragedy of suicide, few evidence-based suicide prevention strategies have been developed. This application proposes to rigorously assess the effectiveness of the Links to Enhancing Teens'Connectedness (LET's CONNECT). This strategy was designed to enhance family and community connectedness and to prevent the onset of suicidal behavior in adolescents who are at elevated risk due to a history of victimization or exposure to interpersonal violence.

DESCRIPTION (provided by applicant): Suicidal behavior is highly prevalent among adolescents in the United States and associated with substantial morbidity. Moreover, suicidal behavior is a primary risk factor for suicide, which is the third leading cause of death for this age group. Despite the public health significance of suicidal behavior and suicide, few evidence-based prevention strategies have been developed for adolescents and even fewer have focused on preventing the initial occurrence of suicidal behavior. In response to RFA- CE-10-006 Prevention of Suicidal Behavior through the Enhancement of Connectedness, this application proposes to rigorously assess the effectiveness of Links to Enhancing Teens' Connectedness (LET's CONNECT) in a randomized controlled prevention trial. LET's CONNECT was designed for adolescents who are at elevated risk for suicidal behavior due to low interpersonal connectedness, a recent history of bullying others, and/or a recent history of being bullied. It teams the adolescent with an adolescent-nominated natural mentor and a community mentor to actively facilitate and support the adolescent's engagement with community organizations and activities. Specific aims are to determine if adolescents in the LET's CONNECT condition relative to adolescents in the control condition (community resource information only): (1) report greater improvement in individual connectedness and community connectedness, and (2) are less likely to engage in suicidal behavior. PUBLIC HEALTH RELEVANCE: Despite the high prevalence of suicidal behavior among adolescents and the too frequent tragedy of suicide, few evidence-based suicide prevention strategies have been developed. This application proposes to rigorously assess the effectiveness of the Links to Enhancing Teens' Connectedness (LET's CONNECT). This strategy was designed to enhance family and community connectedness and to prevent the onset of suicidal behavior in adolescents who are at elevated risk due to a history of victimization or exposure to interpersonal violence.

DESCRIPTION (provided by applicant): Suicidal behavior is a significant concern on college campuses, and suicide is the second leading cause of death in college student populations. Consistent with recommendations in the National Strategy for Suicide Prevention and spearheaded by organizations such as the American Foundation for Suicide Prevention, many universities have initiated voluntary web-based screening to identify students at elevated risk for suicide and in need of mental health services. This is a promising direction; however, research is needed to determine the efficacy of such an approach and how to most effectively link students with positive screens to professional services. With NIMH funding for an R34 intervention development grant, we developed, pilot tested and iteratively refined a theoretically-driven intervention, Students' eBridge to Mental Health (eBridge), which identifies students at elevated suicide risk and facilitates their linkage to mental health (MH) services. eBridge incorporates motivational interviewing (MI) principles and draws from health behavior promotion models that emphasize autonomy and self-determination. Following a web-based screen using standardized instruments to identify students at elevated risk (positive screens on any two or more of: lifetime suicide attempt, current suicidal ideation, alcohol abuse, depression), eBridge offers students the options of receiving personalized feedback (provided online in a conversational MI-adherent format) and corresponding online with professionals trained in MI and knowledgeable about local resources. In our R34 pilot randomized trial, students in the control condition received personalized feedback only, which was provided automatically and in graphic format. At 2-month follow-up, students assigned to eBridge reported (a) significantly higher levels of readiness to seek MH services; (b) significantly lower levels of stigma related to MH services; and (c) a higher likelihood of linking to MH services. In this application, we propose to conduct a large-scale, well-powered randomized controlled intervention trial across multiple universities to address the following specific aims: (1) determine the impact of eBridge on linkage to MH services, MH outcomes (suicidal thoughts and behaviors, depression, alcohol/substance misuse), and academic outcomes (grade point average, retention) at 6-month follow-up; and (2) examine possible moderators (gender, baseline levels of functioning, baseline recognition of problem) and mediators (engagement in online counseling, linkage to MH services) of eBridge effectiveness. Secondary aims include determining the costs associated with, and cost effectiveness of, the intervention. If the intervention is shown to be effective in his large-scale trial, it could be disseminated broadly to address suicide risk and associated mental health conditions and adverse consequences among college adults nationwide.

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.