Project Summary

Description of problem
Alaska has the highest rate of suicide per capita in the country with rates almost twice as high as the rest of the United States (27 versus 14 per 100,000 people). Suicide is the leading cause of death for Alaska Native (AN) youth and young adults ages 15 through 24. Despite its enduring and devastating impacts, the complex issue of AN youth suicide has yet to be adequately addressed in culturally responsive and scientifically grounded ways.

The project team proposes to adapt the Qungasvik (Tools for Life) Prevention (QP) model as a brief intervention for AN youth. QP is an evidence-based and culturally grounded treatment designed to build protection against suicide and alcohol misuse in Yup’ik AN youth 12-18 years old. QP has been shown to increase AN reasons for life and overall resilience. Combining culturally sensitive approaches with evidence-based treatment may be an important way to improve outcomes for youth at risk of suicide. For example, the Motivational Interviewing Social Network intervention (MISN) augments MI with personal network visualization, and has led to significant improvements in young adults’ readiness to change, alcohol use, and network characteristics (e.g., fewer friends they consume alcohol with). The proposed study therefore evaluates a promising intervention for youth age 15-24 that integrates the QP model with MISN.

The aims of the study are to compare outcomes for youth who receive QP only to those who receive QP +MISN to see which subpopulations benefit from either intervention, and to provide an understanding of youth perspectives of culturally centered programming by identifying components most valued by youth and strongly associated with youth outcomes.

Methods
The team proposes to recruit 370 youth across two regional Tribal Health Centers in Alaska. The team will recruit patients ages 15-24 who are admitted to the hospital with a suicide attempt, ideation, or other risks of suicide, such as heavy drinking. All youth will receive a culturally sensitive intervention based on the QP model. Half of the sample will also receive MISN, which will involve visualization and discussion of social networks in the hospital, and two booster sessions two weeks and six weeks later. Youth will complete surveys at baseline, three, six, and 12 months. The team will also interview 40 youth (20 from each intervention group) about their satisfaction with the interventions and suggested recommendations to improve the interventions.

Outcomes
The team will follow youth for one year to evaluate the effects of both QP and QP plus MISN on outcomes. Primary outcomes are suicide intent/risk, mental health, and alcohol use, and secondary outcomes are cultural connectedness, social support, reasons for life, protective factors from alcohol and suicide, and patient satisfaction. The team will also examine for which patient subgroups QP and QP + MISN are most effective, and the team will work closely with the communities to determine how to make the interventions available should they be successful.

Importance to patients
This study is important to AN youth at risk of suicide because there are very few successful treatments that are both culturally relevant and harness knowledge of their social networks to help them make healthier decisions. Both interventions focus on empowering youth and increasing resilience. Suicide also has a profound effect on AN families and communities. Outcomes are important to the community as they will provide an understanding of how culturally centered interventions can unlock local support networks to impact suicide behavior and associated risk and protective factors, to improve individual outcomes.

Stakeholder Engagement
The team has demonstrated a long-term commitment to community-based participatory research with AI/AN populations focused on elimination of health disparities and solutions to prevent suicide. The team has assembled Tribal Oversight Groups to guide it in planning and conducting the study and disseminating study results. The team will engage regional “wellness teams” as stakeholders and collaborators in the research process. Wellness teams will engage at every level of the research: informing adaptation of QP and MISN; advising on cultural and linguistic norms that the team needs to consider, what should be measured and how; assisting with recruitment and retention, and understanding what it all means for the community. The study is set up to facilitate mutual learning and support across researchers and stakeholders to ensure that the work is meaningful and sustainable for AI/AN communities.

Project Information

Elizabeth D'Amico, PhD
Stacy Rasmus, PhD
RAND Corporation
$8,577,038 *

Key Dates

60 months *
July 2021
October 2026
2021
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.

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Last updated: November 23, 2021