Importance There are many prognostic models of suicide risk, but few have been prospectively evaluated, and none has been developed specifically for Native American populations. Objective To prospectively validate a statistical risk model implemented in a community setting and evaluate whether use of this model was associated with improved reach of evidence-based care and reduced subsequent suicide-related behavior among high-risk individuals. Design, Setting, and Participants This prognostic study, done in partnership with the White Mountain Apache Tribe, used data collected by the Apache Celebrating Life program for adults aged 25 years or older identified as at risk for suicide and/or self-harm from January 1, 2017, through August 31, 2022. Data were divided into 2 cohorts: (1) individuals and suicide-related events from the period prior to suicide risk alerts being active (February 29, 2020) and (2) individuals and events from the time after alerts were activated. Main Outcomes and Measures Aim 1 focused on a prospective validation of the risk model in cohort 1. Aim 2 compared the odds of repeated suicide-related events and the reach of brief contact interventions among high-risk cases between cohort 2 and cohort 1. Results Across both cohorts, a total of 400 individuals identified as at risk for suicide and/or self-harm (mean [SD] age, 36.5 [10.3] years; 210 females [52.5%]) had 781 suicide-related events. Cohort 1 included 256 individuals with index events prior to active notifications. Most index events (134 [52.5%]) were for binge substance use, followed by 101 (39.6%) for suicidal ideation, 28 (11.0%) for a suicide attempt, and 10 (3.9%) for self-injury. Among these individuals, 102 (39.5%) had subsequent suicidal behaviors. In cohort 1, the majority (220 [86.3%]) were classified as low risk, and 35 individuals (13.3%) were classified as high risk for suicidal attempt or death in the 12 months after their index event. Cohort 2 included 144 individuals with index events after notifications were activated. For aim 1, those classified as high risk had a greater odds of subsequent suicide-related events compared with those classified as low risk (odds ratio [OR], 3.47; 95% CI, 1.53-7.86; P = .003; area under the receiver operating characteristic curve, 0.65). For aim 2, which included 57 individuals classified as high risk across both cohorts, during the time when alerts were inactive, high-risk individuals were more likely to have subsequent suicidal behaviors compared with when alerts were active (OR, 9.14; 95% CI, 1.85-45.29; P = .007). Before the active alerts, only 1 of 35 (2.9%) individuals classified as high risk received a wellness check; after the alerts were activated, 11 of 22 (50.0%) individuals classified as high risk received 1 or more wellness checks. Conclusions and Relevance This study showed that a statistical model and associated care system developed in partnership with the White Mountain Apache Tribe enhanced identification of individuals at high risk for suicide and was associated with a reduced risk for subsequent suicidal behaviors and increased reach of care.

中文翻译：

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美洲原住民社区自杀风险识别和加强护理模式的评估。

重要性 自杀风险的预后模型有很多，但很少有经过前瞻性评估的模型，而且没有一个是专门针对美洲原住民人群开发的。目的 前瞻性地验证在社区环境中实施的统计风险模型，并评估该模型的使用是否与提高循证护理的覆盖范围以及减少高风险个体中随后的自杀相关行为有关。设计、设置和参与者这项预后研究是与白山阿帕奇部落合作进行的，使用了阿帕奇庆祝生命项目收集的数据，该项目针对 25 岁或以上被确定有自杀和/或自残风险的成年人，从 1 月份开始2017 年 1 月 1 日至 2022 年 8 月 31 日。数据分为 2 个队列：(1) 自杀风险警报激活之前（2020 年 2 月 29 日）期间的个人和自杀相关事件，以及 (2)警报激活后的时间。主要成果和措施 目标 1 侧重于对队列 1 中的风险模型进行前瞻性验证。目标 2 比较了队列 2 和队列 1 中高风险病例重复自杀相关事件的几率以及短暂接触干预的范围。 结果在这两个队列中，共有 400 名被确定有自杀和/或自残风险的个体（平均 [SD] 年龄，36.5 [10.3] 岁；210 名女性 [52.5%]）发生了 781 起自杀相关事件。第 1 组包括 256 名在主动通知之前发生过索引事件的个体。大多数指数事件（134 起 [52.5%]）是暴饮暴食，其次是自杀意念 101 起（39.6%）、自杀未遂 28 起（11.0%）和自残 10 起（3.9%）。在这些人中，102 人（39.5%）随后有自杀行为。在队列 1 中，大多数人 (220 [86.3%]) 被归类为低风险，35 人 (13.3%) 被归类为在指标事件发生后 12 个月内自杀未遂或死亡的高风险。第 2 组包括 144 名在通知激活后出现指数事件的个体。对于目标 1，与低风险人群相比，高风险人群发生后续自杀相关事件的几率更大（比值比 [OR]，3.47；95% CI，1.53-7.86；P = .003；面积接收者操作特征曲线，0.65）。对于目标 2（其中包括两个队列中的 57 名高风险个体），在警报未激活期间，与警报激活时相比，高风险个体更有可能出现随后的自杀行为（OR，9.14；95% CI ，1.85-45.29；P = .007)。在发出主动警报之前，35 名高风险人士中只有 1 人 (2.9%) 接受了健康检查；警报激活后，被归类为高风险的 22 名个人中有 11 名 (50.0%) 接受了 1 次或多次健康检查。