Reducing Suicide Risk in Older Veterans with Mental Health Disorders using Problem Solving Therapy

使用问题解决疗法降低患有精神健康障碍的老年退伍军人的自杀风险

• 批准号: 10398811
• 负责人: Sherry Ann Beaudreau
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10398811
• 关键词: Address; Adult; Aftercare; Alcohols; Anxiety Disorders; Audiotape; Award; Behavior Therapy; Bipolar Disorder; Borderline Personality Disorder; Cessation of life; Clinic; Clinical; Clinical Practice Guideline; Clinical Trials; Cognitive; Color; Columbidae; Communities; Craniocerebral Trauma; DSM-V; Data; Data Analyses; Dementia; Depressive disorder; Distress; Elderly; Emotional; Enrollment; Ensure; Evidence based intervention; Evidence based practice; Evidence based program; Executive Dysfunction; Feedback; Feeling; Feeling hopeless; Feeling suicidal; Future; General Population; Goals; Hour; Infrastructure; Intervention; Living Wills; Mediating; Mediator of activation protein; Medical; Mental Depression; Mental Health Services; Mental disorders; Modeling; Outcome; Participant; Patients; Post-Traumatic Stress Disorders; Primary Health Care; Problem Solving; Protocols documentation; Psychotherapy; Publishing; Qualitative Methods; Randomized; Randomized Controlled Trials; Recommendation; Recording of previous events; Registries; Reporting; Research; Research Design; Risk; Risk Factors; Role; Safety; Schedule; Services; Severities; Site; Substance Use Disorder; Suggestion; Suicide; Suicide attempt; Suicide prevention; Supportive care; Symptoms; Terminal Disease; Testing; Training; Training and Infrastructure; Treatment outcome; Unconscious State; United States Substance Abuse and Mental Health Services Administration; Veterans; Work; active control; age group; aged; base; demographics; diagnostic criteria; disability; efficacious treatment; efficacy evaluation; evidence base; executive function; follow-up; functional disability; improved; optimism; participant safety; problem solving therapy; psychiatric comorbidity; psychotic symptoms; recruit; reducing suicide; response; satisfaction; secondary analysis; skills; stress management; suicidal behavior; suicidal risk; suicide rate; treatment as usual; treatment effect; treatment response

The proposed randomized control trial will examine the efficacy of a brief behavioral treatment for reducing suicidal ideation and for increasing reasons for living in older Veterans at risk for suicide. Two common issues in older adults, functional disability and executive dysfunction, increase suicide risk and will be examined as moderators and mediators of treatment outcomes. The proposed study will examine Problem Solving Therapy (PST) using a protocol that teaches skills to address emotional and practical barriers to effective problem solving. The VA usual care practice of collaborative safety planning will be the control condition, herein referred to as enhanced usual care (EUC). For participant safety, Veterans enrolled in PST will also receive EUC. The study design is random assignment to the treatment, PST plus EUC, or the control condition, EUC only. Both the treatment and the control are evidence-based interventions delivered in six sessions. The study will occur at VA Palo Alto (primary site) and VA Syracuse/VA Canandaigua (secondary site). Longitudinal assessment of suicidal ideation and reasons for living will occur at eleven timepoints: baseline, after each of the six weekly treatment sessions, posttreatment (7 weeks), at 1-, 3-, and 6- month follow-up. The recruitment goal is 150 Veterans over a five-year period with 75 participants randomized to each treatment. Veterans must be 60 years or older, report suicide ideation, and meet diagnostic criteria for a depressive disorder, anxiety disorder, and/or posttraumatic stress disorder to be eligible. Veterans will be excluded and referred for other services if they have psychotic symptoms, bipolar disorder, severe OCD, or elevated symptoms indicative of borderline personality disorder; an alcohol/substance use disorder; severe or unstable medical conditions; recent head injury (past year) or history of a head injury with loss of consciousness for 24 or more hours; terminal illness; positive cognitive screen indicative of possible dementia; or if they are unable to participate in the study or follow-up sessions. Recruitment will occur through multiple strategies at VA, Vet centers, and in the community to ensure the feasibility of recruiting a total of 75 Veterans at each site. To meet this recruitment goal, the primary and secondary site will each enroll 2 to 3 Veterans per month. Fidelity ratings of audiotaped treatment sessions will be made by independent raters on 20% of sessions. Mixed effects modeling will be used to estimate the effect of treatment versus the control for the outcomes of suicidal ideation and reasons for living. Models will covary for demographics, medical and psychiatric comorbidity, and psychotropic use. For the primary aim, models will determine whether PST plus EUC is associated with a larger treatment effect compared with EUC only for suicidal ideation and reasons for living. Secondary aims will determine if baseline functional disability and executive dysfunction moderate treatment outcomes, and whether a change in these two variables from baseline to posttreatment are significantly associated with (mediate) change in suicidal ideation and reasons for living. The tertiary aims will use qualitative methods to assess Veteran satisfaction with the treatment and control including the types of problems with which treatment helped them, and suggestions for improving it for future Veterans. The current VA/DoD Clinical Practice Guidelines (CPGs) for suicide do not list treatment options specifically for older Veterans despite the majority of VHA patients being 55 years or older. Thus, evidence-based outcomes from the proposed work have potential to inform the CPG recommendations for using PST with Safety Planning and/or Safety Planning alone with older Veterans. Dissemination of the treatment could be supported by expanding existing VA training infrastructure in problem solving based interventions.

拟议的随机对照试验将检查简短的行为治疗对于减少 自杀意念以及越来越多的老年退伍军人有自杀风险的原因。两个常见问题 在老年人中，功能障碍和执行功能障碍会增加自杀风险，因此将进行检查 治疗结果的调节因素和中介因素。拟议的研究将探讨问题解决疗法 (PST) 使用一种协议来教授解决有效问题的情感和实际障碍的技能 解决。 VA 协作安全计划的常规护理实践将是控制条件，本文称为 强化常规护理 (EUC)。为了参与者的安全，参加 PST 的退伍军人也将收到 EUC。这 研究设计是随机分配治疗（PST 加 EUC）或对照条件（仅 EUC）。两个都 治疗和控制是循证干预措施，分六次进行。研究将发生 VA Palo Alto（主要站点）和 VA Syracuse/VA Canandaigua（次要站点）。 对自杀意念和生存原因的纵向评估将在十一个时间点进行： 基线、每六周治疗疗程后、治疗后（7 周）、第 1、3 和 6 月随访。招募目标是在五年内招募 150 名退伍军人，其中 75 名参与者 随机分配至每种治疗。退伍军人必须年满 60 岁，报告自杀意念，并满足 抑郁症、焦虑症和/或创伤后应激障碍的诊断标准 有资格的。如果退伍军人出现精神病症状，将被排除并转介接受其他服务， 双相情感障碍、严重强迫症或边缘性人格障碍的症状加重；一个 酒精/药物滥用障碍；严重或不稳定的医疗状况；最近头部受伤（去年） 或有头部受伤史且意识丧失 24 小时或更长时间；绝症；积极的 认知筛查表明可能患有痴呆症；或者如果他们无法参加研究或 后续会议。退伍军人管理局、兽医中心和医院将通过多种策略进行招募 社区，以确保每个地点招募总共 75 名退伍军人的可行性。为迎接本次招聘 为了实现这一目标，主要站点和次要站点每月将分别招收 2 至 3 名退伍军人。 录音治疗课程的保真度评级将由独立评估者对 20% 的课程进行。 混合效应模型将用于估计治疗效果与对照结果的比较 自杀意念和生存的原因。模型将针对人口统计、医学和精神病学而变化 合并症和精神药物的使用。对于主要目标，模型将确定 PST 加 EUC 是否是 与 EUC 相比，仅针对自杀意念和生存原因具有更大的治疗效果。 次要目标将确定基线功能障碍和执行功能障碍是否可以缓和治疗 结果，以及这两个变量从基线到治疗后的变化是否显着 与自杀意念和生活原因的（中介）改变有关。第三目标将使用 评估退伍军人对治疗和控制满意度的定性方法，包括治疗类型 治疗对他们有帮助的问题，以及为未来退伍军人改善问题的建议。目前的 VA/DoD 自杀临床实践指南 (CPG) 并未列出专门针对老年人的治疗方案 尽管大多数 VHA 患者年龄都在 55 岁或以上，但都是退伍军人。因此，基于证据的结果 拟议的工作有可能为 CPG 关于在安全规划中使用 PST 的建议提供信息 和/或与年长退伍军人单独制定安全计划。可以通过以下方式支持治疗的传播： 扩大现有的退伍军人管理局培训基础设施，以解决问题为基础的干预措施。