The Center for Enhancing Treatment and Utilization for Depression and Emergent Suicidality (ETUDES) in Pediatric Primary Care

This is a resubmission application for a Practice-based Suicide Prevention Center (PAR-20-286), and a competitive renewal of our current Alacrity P50, ETUDES, which continues to focus on the development of tools to augment the capacity of pediatric primary care (PPC) to detect, triage, and manage suicidal youth. We aim to address the crisis in adolescent suicide, with a major emphasis on youth who are at high risk due to high exposure to risk factors for suicide and lack of ready access to quality mental healthcare (MH). We focus on PPC because most youth visit PPC annually, when they are routinely screened for depression and suicidal risk. This Center renewal convenes a multi-disciplinary team, with expertise in intervention development, machine learning, computer science, mobile sensing, social media, health economics, health disparities, and implementation science.

We prioritize training early career scientists (ECS), 14 of whom play major roles in Center studies and leadership. We will also recruit nationally for promising from multiple professional disciplines to receive training and mentorship through the Center. All aims are guided by collaboration with stakeholder groups of youth, caregivers, clinicians, and healthcare leaders, some of whom play leadership roles in the Center. In the R01, we will optimize, test, and deploy machine learning algorithms for the prediction of suicide attempts (SA) in practice networks in Pittsburgh and Philadelphia.

The R01 also serves as the gateway for all 1200 participants in the Center, who will be assessed for individual, family, and contextual risk and protective factors for SA at intake and over 12 months of follow-up. In the second component of the R01, 900 suicidal youth will be randomized to usual care or to a suite of tools (iCHART) that we developed during the previous project period that increased physician referrals to mental health and patient treatment engagement and reduced suicidal ideation and SAs. The remaining 300 youth, who screen positive for depression, half of whom will be suicidal, will be allocated to one of 3 R34s to develop interventions that target online victimization, anhedonia, and poor sleep, respectively, all risk factors for SAs. We will develop and test the feasibility and acceptability of novel methods using mobile sensing and social media data to detect inflections in suicidal risk in a subset of 500 youth.

We will assess barriers and facilitators to implementation, feasibility, usability, and acceptability for our interventions and assessments; and assess cost for iCHART and our predictive analytics. Our study sample will be demographically representative of these two PPC networks, and we will apply implementation science methods to ensure that all Center products are acceptable and effective for all youth and their families. All Center protocols, presentations, trainings, and products will be freely available on the Center website. The Center will produce PPC-based care pathways for suicidal adolescents that can substantially reduce suicide-related events and will train a promising. multi-disciplinary national cohort of ECS focused on the prevention of youth suicide.

Grant Number: 5P50MH115838-08
NIH Institute/Center: NIH
Principal Investigator: David Brent