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，尤其是患有严重精神疾病的退伍军人 （SMI，即精神障碍或双相情感障碍）这些退伍军人的自杀率最高。 然而，SMI 诊断往往是一种排除。 以自杀为中心的临床试验的标准，并且患有 SMI 的人经常脱离护理， 认知障碍和社会支持有限这些因素可能会影响可行性和 当前自杀预防干预措施的有效性，例如自杀安全计划——VHA 标准 该提案完善并试点了同伴提供康复策略的自杀预防（支持）—— 第一个针对患有 SMI 的退伍军人量身定制的自杀预防干预措施，以改善他们的生活参与度 社会。 意义/创新：预防自杀是 VA/DoD 和 RR&D 的临床首要任务。 其创新有以下几个原因：1) SMI 诊断经常被排除在自杀预防之外 研究和该提案旨在专门针对患有以下疾病的退伍军人制定一种新颖的以自杀为重点的干预措施 SMI；2) 该提案是少数涉及 SMI 退伍军人以加强安全规划的研究之一， 鉴于这是 VHA 现有的自杀预防护理标准，这一点至关重要 3) 该提案整合了 预防自杀的恢复模式和最佳实践；4) 由同行专家提供支持； 2019 年 VA/DoD 风险患者评估和管理临床实践指南 for Suicide 强调了未来研究的一个优先事项，即探索“急性后护理方法”，例如安全性 规划，并且此类方法可以同行交付；5）这是第一个整合的干预措施； 以自杀为中心的干预中的认知学习策略，以适应 SMI 的认知障碍。 方法：拟议的 5 年研究旨在完善和试点同行提供的干预措施，以改善 降低自杀风险的功能和社会恢复；该提案由两个阶段组成：第一阶段（1.5）。 年）采用以用户为中心的设计方法，在科学和消费者的帮助下完善支持（n=8） 咨询委员会利益相关者以及培训我们的 PS 在公开审判中忠实于试点案例 (n=15) 以及 支持是一项为期 4 周的同行干预，旨在加强安全规划。 通过解决针对每位退伍军人在自杀危机后康复的个性化功能和社会目标 同时包括认知学习策略，以增强后续干预材料的记忆和显着性。 第 1 阶段、第 2 阶段（3.5 年）的改编包括一项试点 (n=50) 随机对照试验 (RCT) 支持与包含标准要素的增强标准护理 (ESC) 条件相比 实践 VHA 提供的自杀预防措施，其中包括：1) 自杀风险评估，2) VA 安全规划 干预，3) 及时转诊至 VA 心理健康门诊护理，以及 4) 自杀预防协调员 两个阶段的后续接触者将在基线、中期进行定量评估。 治疗、治疗后和治疗后 3 个月（并在治疗后进行定性访谈；同行 提供干预措施的专家也将在治疗后接受定性访谈）。 待评估的结果是个人康复的改善和自杀意念严重程度的降低。 次要结果涉及个人和社会功能各个领域的变化。 后续步骤：CDA-2 是 VHA 内开发研究计划的第一步，重点关注 通过为退伍军人量身定制以康复为中心的以自杀为重点的干预措施，加强与自杀相关的护理 在确认可行性和初步影响之前，Chalker 博士将向 SMI 提交 RR&D 优点申请。 探索 SUPPORT 与 ESC 的多地点、充分动力的 RCT 我们强调 1) 检查。 主持人或利益团体（例如女性退伍军人）的意见和 2) 支持变革机制。