A Novel Peer-Delivered Recovery-Focused Suicide Prevention Intervention for Veterans with Serious Mental Illness

针对患有严重精神疾病的退伍军人的新型同伴交付的以康复为重点的自杀预防干预措施

• 批准号: 10536426
• 负责人: SAMANTHA CHALKER
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-11-01 至 2027-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10536426
• 关键词: Address; Advocate; Aftercare; Ambulatory Care; Area; Award; Bipolar Disorder; Caring; Clinical; Clinical Practice Guideline; Clinical Services; Clinical Trials; Cognitive; Cognitive deficits; Communities; Coping Skills; Counseling; Development; Diagnosis; Effectiveness; Elements; Evidence based practice; Exclusion; Exclusion Criteria; Feeling suicidal; Foundations; Goals; Group Therapy; Hospitalization; Impaired cognition; Interest Group; Intervention; Interview; Learning; Maps; Memory; Mental Health; Mental disorders; Mentors; Mentorship; Methodology; Mission; Modeling; Outcome; Participant; Patients; Persons; Phase; Prevention Research; Protocols documentation; Psychotic Disorders; Public Health; Quality of life; Randomized, Controlled Trials; Recommendation; Recovery; Research; Research Personnel; Risk Assessment; Safety; Services; Severities; Site; Social Functioning; Social support; Societies; Specialist; Statistical Methods; Suicide; Suicide prevention; Telephone; Training; Veterans; Woman; acceptability and feasibility; acute care; brief intervention; cognitive training; coping; design; experience; follow-up; functional independence; improved; innovation; learning strategy; military veteran; novel; peer; pilot trial; prevent; preventive intervention; primary outcome; programs; psychosocial; recruit; retention rate; satisfaction; secondary outcome; severe mental illness; skills; skills training; social; standard care; standard of care; suicidal; suicidal behavior; suicidal risk; suicide rate; tool; uptake; user centered design

Background: Suicide is a major public health concern, particularly among Veterans with serious mental illness (SMI, i.e., psychotic disorders or bipolar disorders). These Veterans have among the highest rates of suicidal ideation and behavior among U.S. and Veteran populations. Yet, an SMI diagnosis is often an exclusion criterion for suicide-focused clinical trials, and people with SMI are frequently disengaged from care, have cognitive impairments, and have limited social supports. These factors may likely impact the feasibility and usefulness of current suicide prevention interventions such as suicide safety planning – a VHA standard of care. This proposal refines and pilots SUicide Prevention by Peers Offering Recovery Tactics (SUPPORT) – the first suicide prevention intervention tailored to Veterans with SMI to improve participation in their lives and society. Significance/Innovation: Suicide prevention is a top clinical priority for VA/DoD and RR&D. This research is innovative for several reasons: 1) SMI diagnoses have frequently been excluded from suicide prevention research and this proposal seeks to tailor a novel suicide-focused intervention specifically to Veterans with SMI; 2) this proposal is one of few studies that includes Veterans with SMI to enhance safety planning, which is crucial given that it is an existing suicide prevention standard of care in VHA; 3) this proposal integrates the recovery model and best practices into suicide prevention; 4) SUPPORT is delivered by Peer Specialists, which the 2019 VA/DoD Clinical Practice Guidelines for the Assessment and Management of Patients at Risk for Suicide highlighted a priority for future research to explore “post-acute care approaches,” such as safety planning, and that such approaches could be peer-delivered; 5) this is the first intervention to integrate cognitive learning strategies in a suicide-focused intervention to accommodate cognitive impairments in SMI. Methodology: The proposed 5-year study aims to refine and pilot a peer-delivered intervention to improve functional and social recovery to decrease suicide risk; the proposal consists of two phases. Phase 1 (1.5 years) employs a user-centered design approach to refine SUPPORT aided by scientific and consumer (n=8) advisory board stakeholders as well as training our PSs to fidelity on pilot cases in an open trial (n=15) and qualitative interviews. SUPPORT is a 4-week peer-delivered intervention intended to augment safety planning by addressing functional and social goals personalized to each Veteran’s recovery following a suicidal crisis while including cognitive learning strategies to enhance recall and salience of intervention material. Following adaptations from Phase 1, Phase 2 (3.5 years) includes a pilot (n=50) randomized controlled trial (RCT) of SUPPORT compared to an enhanced standard care (ESC) condition that contains the elements of standard practice suicide prevention delivered at VHA, which include: 1) suicide risk assessment, 2) VA Safety Planning Intervention, 3) timely referral to VA mental health outpatient care, and 4) Suicide Prevention Coordinator follow-up contacts. Veteran participants in both phases will be quantitatively assessed at baseline, mid- treatment, post-treatment, and 3-months post-treatment (and qualitatively interviewed at post-treatment; Peer Specialists delivering the intervention will also be qualitatively interviewed post-treatment). The primary outcomes to be evaluated is improvement in personal recovery and reduction in suicidal ideation severity. Secondary outcomes concern changes in various domains of personal and social functioning. Next Steps: This CDA-2 is the first step toward developing a program of research within VHA focused on enhancing suicide related care by tailoring recovery-informed suicide-focused interventions to Veterans with SMI. Pending confirmation of feasibly and preliminary impact, Dr. Chalker would submit for an RR&D Merit to explore a multi-site, adequately powered RCT of SUPPORT versus ESC. We would emphasize 1) examination of moderators or groups of interest (such as women Veterans) and 2) SUPPORT mechanisms of change.

背景：自杀是一个主要的公共卫生问题，尤其是在患有严重精神疾病的退伍军人中 （SMI，即精神病或双相情感障碍）。这些退伍军人的自杀率最高 美国和退伍军人人口的思想和行为。但是，SMI诊断通常是排除 以自杀为重点的临床试验和SMI的人经常被脱离护理的标准， 认知障碍，社会支持有限。这些因素可能会影响可行性和 当前预防自杀干预措施（例如自杀安全计划）的有用性 - VHA标准的 关心。该提案通过提供恢复策略（支持）的同龄人来完善和预防猪预防猪 - 首次针对SMI的退伍军人量身定制的第一次自杀预防干预措施，以改善他们的生活和 社会。 意义/创新：预防自杀是VA/DOD和RR＆D的最高临床优先级。这项研究是 创新的原因有几个：1）SMI诊断经常被排除在预防自杀之外 研究和该提议旨在为专门针对具有的新型自杀干预量调整 smi; 2）该提案是包括具有SMI的退伍军人，以增强安全计划，这是为数不多的研究之一 鉴于它是VHA中现有的自杀预防标准，至关重要； 3）该提案集成了 恢复模型和预防自杀的最佳实践； 4）支持由同伴专家提供 2019年VA/DOD临床实践指南，用于评估和管理处于危险的患者 自杀强调了将来研究的优先事项，以探索“急性后护理方法”，例如安全 计划，并且可以同行交付这种方法； 5）这是第一个整合的干预措施 以自杀为中心的干预措施中的认知学习策略可以适应SMI的认知障碍。 方法论：拟议的5年研究旨在完善和试点同行提供干预措施以改进 功能和社会恢复以降低自杀风险；该提案包括两个阶段。阶段1（1.5 年）员工以用户为中心的设计方法来完善科学和消费者的帮助（n = 8） 顾问委员会利益相关者以及在公开试验（n = 15）和 定性访谈。支持是一项为期4周的同行干预措施，旨在增加安全计划 通过解决自杀危机后每个退伍军人恢复的个性化功能和社会目标 同时包括认知学习策略，以增强干预材料的回忆和显着性。下列的 第1阶段的改编，第2阶段（3。5年）包括一个飞行员（n = 50）随机对照试验（RCT） 与增强的标准护理（ESC）条件相比，支持标准要素 VHA提供的自杀预防练习，其中包括：1）自杀风险评估，2）VA安全计划 干预，3）及时转诊至VA心理健康门诊护理，4）预防自杀协调员 后续联系人。这两个阶段的退伍军人参与者将在基线时进行定量评估 治疗，治疗后和3个月后治疗（并在治疗后进行定性采访； 提供干预的专家也将进行定性采访后处理后）。主要 要评估的结果是自杀念头严重程度的个人康复和减少的改善。 次要结果涉及个人和社会功能的各个领域的变化。 下一步：此CDA-2是在VHA中开发研究计划的第一步 通过针对退伍军人定制以自杀的自杀性干预来增强自杀相关的护理 smi。尚待确认可行和初步影响，Chalker博士将提交RR＆D优点 探索一个多站点，足够的支持RCT与ESC。我们将强调1）考试 主持人或感兴趣的群体（例如妇女退伍军人）和2）支持变化机制。