Group (“Project Life Force”) vs. Individual Suicide Safety Planning RCT

团体（“生命力计划”）与个人自杀安全计划随机对照试验

• 批准号: 10295174
• 负责人: Marianne Goodman
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-10-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10295174
• 关键词: Accident and Emergency department; Adherence; Adult; Aftercare; Age; Ambulatory Care; Behavior Therapy; Caring; Cognitive Therapy; Combined Modality Therapy; Communities; Coping Skills; Data; Development; Development Plans; Dialectical behavior therapy; Effectiveness; Family; Feeling hopeless; Feeling suicidal; Fostering; Friends; Friendships; Funding; Future; Group Psychotherapy; Guidelines; Guns; Hour; Individual; Intervention; Learning; Life; Loneliness; Manuals; Mediating; Mental Depression; Mental Health; Methodology; Methods; Monitor; Participant; Pattern; Personal Satisfaction; Philadelphia; Play; Population; Public Health; Publishing; Randomized Clinical Trials; Recovery; Reporting; Resources; Risk; Risk Factors; Role; Safety; Site; Stress; Suicide; Suicide attempt; Suicide prevention; System; Telephone; Testing; Time; Training; United States National Center for Health Statistics; Universities; Update; Veterans; Work; base; cohesion; coping; design; distress tolerance; effective intervention; emotion regulation; follow up assessment; follow-up; group intervention; high risk; improved; military veteran; novel; novel strategies; post intervention; prevention service; primary outcome; psychoeducational; rehabilitation research; research and development; secondary outcome; skills; standard of care; suicidal; suicidal behavior; suicidal individual; suicidal morbidity; suicidal risk; suicide hotline; suicide rate; therapy development; treatment as usual; treatment response

Despite the enrichment of VA suicide prevention services and implementation of the national suicide hotline, Veteran suicide completions occur 20 times per day and suicide attempts numbered over 15,000 in 2012. These data underscore the urgency of developing additional interventions targeting suicidal Veterans. The construction of a Suicide Safety Plan (SSP); a “best practice,” is mandated throughout the VA system, and a vital component of the VA’s coordinated effort at suicide prevention and recovery. Safety Planning in Veterans presenting to an emergency room has been shown to decrease suicide behavior. To our knowledge, there are currently no recommended guidelines or mechanisms for refinement of the SSP in adult populations beyond its initial development. “Project Life Force” (PLF), a novel suicide safety planning group intervention has been designed to fill this critical gap and provide a mechanism to develop and enhance suicide safety planning over time. PLF, a 10-session, group psychotherapy intervention, combines Dialectical Behavioral Therapy (DBT) skill based and psychoeducational approaches, to enhance suicide safety planning development and implementation. Veterans revise their plans over several weeks while learning distress tolerance, emotion regulation, and friendship building/interpersonal skills to incorporate into their safety plans and also receive lessons on gun safety and minimizing access to lethal means, augmenting physical well being and strategies how to share their plan with family/significant others and their treatment team. Importantly, the group format mitigates loneliness and fosters increased “belongingness,” both key risk factors for suicide. Additionally, PLF’s weekly format facilitates VA-mandated monitoring for any Veteran placed on the suicide “high risk” list. PLF received pilot SPiRE funding from the VA Rehabilitation and Research Development in 2015 to finalize the development of the intervention’s manual and pilot the intervention in Veterans. Preliminary data suggests high levels of feasibility, and acceptability. 100% of participants developed updated safety plans and increased use patterns and a significant decrease in suicidal ideation. This project’s aim is to conduct a multi-site (James J Peters VAMC and Philadelphia VA) randomized clinical trial (RCT) of PLF versus treatment as usual (TAU) that includes individual telephone review of safety plans in 265 suicidal Veterans with follow up to one year. The primary outcome variable is suicidal behavior, using a rigorous, multi-method assessments follow-up. Secondary outcomes include depression, hopelessness and treatment utilization. Exploratory analyzes will examine whether changes in suicide coping and levels of group cohesion in PLF mediate treatment response. Methodological rigor includes ongoing adherence ratings for PLF and assessment training/monitoring by an independent third site (Columbia University).

尽管退伍军人管理局的自杀预防服务不断丰富并实施了国家 自杀热线、退伍军人自杀事件每天发生 20 次，并且自杀未遂 2012 年数量超过 15,000 个。这些数据强调了开发更多 针对有自杀倾向的退伍军人的干预措施；制定自杀安全计划（SSP）； “最佳实践”是整个 VA 系统的强制要求，也是 VA 的重要组成部分 退伍军人自杀预防和康复安全规划的协调工作。 据我们所知，急诊室已被证明可以减少自杀行为。 目前尚无针对成人 SSP 细化的推荐指南或机制 “生命力计划”（PLF）是一种新颖的自杀安全措施。 规划小组干预旨在填补这一关键空白并提供一种机制 随着时间的推移制定和加强自杀安全计划 PLF，这是一个由 10 次会议组成的小组。 心理治疗干预，结合了基于技能的辩证行为治疗（DBT）和 心理教育方法，加强自杀安全规划的制定和 退伍军人在几周内修改他们的计划，同时学习痛苦。 宽容、情绪调节和建立友谊/人际交往能力纳入他们的 安全计划，并接受有关枪支安全和尽量减少获取致命手段的课程， 增强身体健康和策略 如何与家人/重要人士分享他们的计划 重要的是，小组形式可以减轻孤独感并促进。 此外，PLF 的每周形式也增加了“归属感”，这是自杀的两个关键风险因素。 促进 VA 强制对列入自杀“高风险”名单的退伍军人进行监测。 2015 年获得 VA 康复和研究发展部的试点 SPiRE 资助 最终确定干预手册的制定，并对退伍军人进行干预试点。 初步数据表明可行性很高，并且 100% 的参与者都接受。 制定更新的安全计划并增加使用模式并显着减少 自杀意念。 该项目的目标是进行多站点（James J Peters VAMC 和 Philadelphia VA） PLF 与常规治疗 (TAU) 的随机临床试验 (RCT)，其中包括个体 对 265 名有自杀倾向的退伍军人的安全计划进行电话审查，并进行长达一年的跟踪。 主要结果变量是自杀行为，使用严格的多方法评估 次要结局包括抑郁、绝望和治疗利用。 探索性三元组将检查自杀应对和群体水平是否发生变化 PLF 介导的治疗反应中的凝聚力包括持续的依从性。 由独立的第三方站点（哥伦比亚）进行的 PLF 评级和评估培训/监控 大学）。