2013 — 2016 |
Pisani, Anthony R |
K23Activity Code Description: To provide support for the career development of investigators who have made a commitment of focus their research endeavors on patient-oriented research. This mechanism provides support for a 3 year minimum up to 5 year period of supervised study and research for clinically trained professionals who have the potential to develop into productive, clinical investigators. |
Mobile Phone Intervention to Prevent Youth Suicide in Rural Communities @ University of Rochester
DESCRIPTION (provided by applicant): Reducing youth suicide has been named as a national priority for more than a decade, yet rates of youth suicide and suicide attempts have not declined. Suicide is still the 3rd leading cause of death for ages 10 - 24, and suicide rates i rural communities are more than double the national average. The public health impact of commonly applied strategies, such as gatekeeper training, is limited by minimal communication between adolescents and adults, minimal help seeking by adolescents, and by problems with accessibility and acceptability of mental health services. These barriers are particularly relevant in rural and underserved communities, which have 2-10 times higher youth suicide rates and lower utilization of available services. School-based, population oriented strategies overcome some of these limitations, but existing programs have yet to harness mobile communication devices to reach adolescents with preventive interventions directly, even beyond the school context. Text messaging is low-cost, effective tool for changing health behaviors, and is emerging as a powerful public health tool for influencing adolescent risk behavior. My application would be the first extension of mobile devices into population-based suicide prevention. The K23 career development award will provide me with the education and experience I need to become an independent investigator focused on developing and testing mobile-mediated public health interventions to reduce youth suicide. This proposal has three career development goals: Goal 1. Intervention Development. Learn the principles and practices needed to develop a safe, engaging, and effective mobile-mediated mental health intervention to target suicide risk and protective processes for youth. Goal 2. Prevention Trial Design. Gain expertise and collaborators to select and sequence prevention trial designs and research methods that are suitable for testing flexible electronically-delivered interventions for youth. Gol 3. mHealth Knowledge. Gain scientific and technical knowledge to collaborate effectively with technical experts and to assess opportunities for mHealth technologies in youth suicide prevention. I developed a research project that provides a framework for meeting these career development goals. My research objective is to develop and test the effects of a suicide preventive intervention delivered to adolescents via mobile technology. To achieve this objective my project has three aims: Aim 1. Development. Develop a safe and engaging text messaging intervention (Text4Strength) to strengthen adolescent's emotion self-regulation skills and resources. Aim 2. Field Testing. Assess the usage, usability, participant perceptions, and system operation of Text4Strength by conducting a field test of with 43 adolescents, and revise the intervention as needed. Aim 3. Pilot RCT. Assess the promise of Text4Strength. Assess the impact of Text4Strength on key proximate targets examining: skills in monitoring emotions, reducing escalation, and using adult relational resources to maintain emotional equilibrium. Secondarily, I will explore the intervention's impact on psychological distress, depressive symptoms, anxiety symptoms, and suicide ideation. The career development plan anchored by this research project will give me the skills, experiences, collaborators, and technical infrastructure that I need to be a leading expert in applying mobile technology to prevent youth suicide in rural communities. By putting an option-rich intervention in the hands of youth in rural communities, the proposed research addresses NIMH priorities: Strategic Objective 3 to improve and personalize mental health interventions; Strategy 4.1 to test novel models and methods to bring mental health interventions to diverse groups, including rural communities.
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0.961 |
2019 — 2021 |
Pisani, Anthony R |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Effectiveness of a Targeted Brief Intervention For Recent Suicide Attempt Survivors @ University of Rochester
Suicide rates are rising in the US and more than a million Americans try to take their own lives each year. Effective, brief, low-cost interventions for individuals who attempt suicide are essential to saving lives and achieving the goals of the National Strategy for Suicide Prevention. This proposal takes advantage of a time- sensitive research opportunity to test the effectiveness of the Attempted Suicide Short Intervention Program (ASSIP), a manualized 3-session intervention for recent suicide attempt survivors that produced dramatic reductions in suicide attempts in a efficacy trial?80% fewer reattempts and an average of 72% fewer hospital days over 24 months in the intervention group compared to controls. Our research will now test its effectiveness of in the US public mental health care system, examine theoretically grounded mechanisms, and explore cost-effectiveness. ASSIP is currently being implemented by New York State in a Zero Suicide initiative funded by SAMHSA. Consistent with NIMH Notice of Interest MH-17-031, our project leverages this federal investment and a strong state partnership to conduct effectiveness research. Our project has three aims: Aim 1. Effectiveness. The primary aim of this study is to determine the effectiveness of ASSIP in reducing suicide reattempts in a community mental health setting in the U.S. To accomplish this aim we will conduct a randomized controlled trial with 400 individuals referred from psychiatric inpatient and emergency services following a suicide attempt. Participants will be randomized to receive either usual care + ASSIP (intervention arm) or usual care only (control arm), and followed for assessments at baseline, 3, 6, 12, and 18 months. Aim 2. Mechanism. The secondary aim of this study to examine the psychological mechanisms of ASSIP as predicted by the Interpersonal Theory of Suicide. We will conduct statistical analyses of a mediation model to determine (a) whether ASSIP improves perceptions of low belonging and being a burden on others, and (b) whether the effect of treatment on reductions in suicide re-attempts is mediated by these improvements. Aim 3. Cost-Effectiveness. The exploratory aim of this study is to estimate, from the perspective of an ASSIP provider, the incremental cost per suicide attempt averted by delivering ASSIP to supplement usual care following a suicide attempt. We will gather pre-implementation accounting data, personnel time logs, and 12- month medical record reports of emergency and inpatient psychiatric visits. We will use these data together with effectiveness results to calculate the incremental cost-effectiveness ratio (ICER). This time-sensitive study builds effectiveness research into a federally-funded Zero Suicide grant to New York state, consistent with a specific request from NIMH for such applications. If hypotheses are supported, the study will provide evidence of a brief, practical, and novel therapy that reduces suicide reattempts in a real-world health setting. If hypotheses are supported, the study will provide evidence of a brief, practical, and novel therapy that reduces suicide reattempts in a real-world health setting.
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0.961 |