Supporting Relationships to Reduce Suicide Risk: A Randomized Control Trial of the Brief Relationship Checkup

支持关系以降低自杀风险：简短关系检查的随机对照试验

• 批准号: 10538824
• 负责人: Dev J Crasta
• 金额: --
• 依托单位: VETERANS AFFAIRS, UNITED STATES DEPARTMENT OF
• 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/10538824
• 关键词: Address; Adherence; Aftercare; Air; Caring; Clinical Trials; Competence; Couples; Couples Therapy; Data; Distress; Elements; Family; Feeling suicidal; Foundations; Functional disorder; Funding; Goals; Impaired health; Impairment; Individual; Intervention; Learning; Manuals; Marriage; Measures; Mental Depression; Mental Health; Mental Health Services; Modeling; Participant; Policies; Population; Post-Traumatic Stress Disorders; Prevention; Prevention approach; Prevention strategy; Primary Care; Psychotherapy; Randomized; Randomized, Controlled Trials; Reporting; Research; Research Project Grants; Risk; Risk Factors; Risk Management; Sampling; Science; Strategic Planning; Structure; Suicide; Suicide prevention; Symptoms; Techniques; Telephone; Testing; Time; Training; Validation; Value of Life; Veterans; Veterans Health Administration; acceptability and feasibility; active duty; alcohol misuse; associated symptom; career; checkup examination; collaborative care; community clinic; depressive symptoms; design; experience; help-seeking behavior; high risk; improved; indexing; innovation; motivational enhancement therapy; open label; pilot trial; programs; protective factors; recruit; reducing suicide; satisfaction; screening; selective prevention; service member; standard of care; suicidal morbidity; suicidal risk; treatment effect

Romantic relationship distress is a common impairment among Veterans struggling with depression, posttraumatic stress disorder (PTSD), alcohol misuse, and suicide risk. In a study of Veterans who screened positive for the above concerns in primary care, 58% of partnered Veterans reported romantic relationship problems. Relationship problems are also a prominent risk factor for suicide, preceding 24% of Veteran suicide deaths and 50% for Veterans 18-35. Conversely, full participation in mutually supportive relationships confers protection against suicide. This suggests we may be able to offset risk by turning distressed relationships into protective partnerships. Unfortunately, the intensive formats of existing couple therapies result in couples discontinuing after 2-3 sessions or delaying treatment until they are close to breakup. This underscores the need for brief relationship support that is accessible through primary care mental health (PC-MHI). The Brief Relationship Checkup (BRC) is a three 30-minute session intervention to address relationship distress. BRC incorporates a combination of couple therapy and motivational interviewing techniques to encourage couples to make concrete commitments to improve their relationship. BRC demonstrates efficacy in reducing suicide risk factors such as relationship dysfunction and promoting protective factors such as mutual responsiveness to one another’s concerns, a core element of supportive relationships. Earlier Checkup programs have also been shown to increase individual and couple therapy engagement and reduce depressive symptoms. In an open label pilot trial, we found BRC was feasible and acceptable to Veterans screening positive on VHA mental health primary screens. We also found its highly structured framework could be learned by trainees without prior couple therapy experience. RESEARCH PLAN: We propose a pilot randomized controlled trial (RCT) of BRC administered to 72 couples to evaluate its ability to modify suicide risk/protective factors. Participants will be screened by phone to identify couples that are in distressed committed relationship where at least one partner is a Veteran (the “Target Veteran”) who screens positive on a primary care mental health screen for common suicide risk factors (i.e., suicide ideation, depression, PTSD, alcohol misuse). We will randomize couples to BRC or to three sessions of the current PC-MHI Co-Located Collaborative Care model (CCC) for the Veteran partner only. All participants will complete baseline, post-treatment, 3-month, and 6-month assessments. The study will provide the foundations for a larger clinical trial proposal through pursuit of the following research aims and hypotheses (H): AIM 1: Determine BRC’s efficacy in improving relationship factors related to suicide for both partners. H1a. Couples in BRC will report greater reductions in relationship dysfunction than those in CCC. H1b. Couples in BRC will report greater increases in mutual responsiveness than those in CCC. AIM 2: Determine BRC’s efficacy in improving individual factors related to suicide for the Target Veteran. H2a. Target Veterans in BRC will show greater therapy utilization via chart review than those in CCC. Sub-aim 2b. Estimate associations between Target Veterans’ BRC participation and change in mental health symptoms associated with suicide risk (i.e., depression; PTSD; and alcohol misuse). Sub-aim 2c. Explore associations between change in risk factors and changes in Veteran suicide ideation. AIM 3: Develop and validate a fidelity codebook to operationalize BRC adherence and clinician competency. CAREER PLAN: Dr. Crasta will use each of the above research aims as an opportunity to pursue the complementary training aims that were selected based on a prevention science framework: Training Aim 1: Gain experience designing and conducting dyadic RCTs in a suicide prevention context. Training Aim 2: Develop expertise in analyzing clinical trial data. Training Aim 3: Learn the fundamentals of developing implementable interventions.

浪漫的关系困扰是苦苦挣扎的退伍军人中常见的障碍， 创伤后应激障碍（PTSD），滥用酒精和自杀风险。在对筛选的退伍军人的研究中 对上述初级保健的上述担忧呈阳性，有58％的伙伴退伍军人报告了浪漫关系 问题。关系问题也是自杀的重要危险因素，在24％的退伍军人自杀之前 死亡人数和50％的退伍军人18-35。相反，充分参与相互支持的关系同意 防止自杀。这表明我们可能能够通过将不良关系变成的风险来抵消风险 保护伙伴关系。不幸的是，现有夫妇疗法的密集格式导致夫妻 在2-3次课程或延迟治疗后停止进行，直到它们接近分手。这突显了需求 对于通过初级保健心理健康（PC-MHI）可以获得的简短关系支持。 简短的关系检查（BRC）是三个30分钟的会议干预措施，以解决关系 困扰。 BRC结合了夫妇疗法和动机访谈技术的组合 鼓励夫妻做出具体的承诺以改善他们的关系。 BRC证明了效率 减少自杀危险因素，例如关系功能障碍和促进保护因素，例如相互 对彼此关注的反应，这是支持性关系的核心要素。较早的检查程序 还显示出可以增加个人和夫妇治疗的参与并减轻抑郁症状。 在一项开放标签试验试验中，我们发现BRC是可行的，并且可以接受退伍军人对VHA呈阳性的筛查 心理健康初级屏幕。我们还发现它的高度结构化框架可以通过培训来学习 没有以前的夫妇治疗经验。 研究计划：我们提出了一项针对72对夫妇的BRC随机对照试验（RCT） 评估其修改自杀风险/保护因素的能力。参与者将通过电话筛选以识别 处于困境的恋爱关系中的夫妻至少有一个伴侣是老兵（“目标” 退伍军人”）在初级保健心理健康屏幕上筛选出正面自杀危险因素（即 自杀想法，抑郁症，PTSD，滥用酒精）。我们将将夫妇随机为BRC或三个会议 当前的PC-MHI仅针对退伍军人合作伙伴共同定位的协作护理模型（CCC）。所有参与者 将完成基线，治疗后，3个月和6个月的评估。该研究将提供 通过追求以下研究的目的和假设（H），为更大的临床试验提案提供了基础： 目标1：确定BRC在改善双方自杀有关的关系因素方面的效率。 H1a。 BRC中的夫妻将报告与CCC中的关系功能障碍的减少更大。 H1b。 BRC中的夫妻将报告相互响应的增加比CCC中的响应能力更大。 目标2：确定BRC在改善目标退伍军人自杀相关的个人因素方面的效率。 H2A。 BRC中的目标退伍军人将通过图表审查显示出比CCC中的治疗方法更大的治疗方法。 sub-aim 2b。估计目标退伍军人的BRC参与与心理健康变化之间的关联 与自杀风险相关的症状（即抑郁； PTSD；滥用酒精）。 Sub-aim 2C。探索风险因素变化与退伍军人自杀想法变化之间的关联。 目标3：开发和验证一本富达代码手册，以实现BRC依从性和临床能力。 职业计划：Crasta博士将使用上述每项研究的目的是追求 完全根据预防科学框架选择的培训目标： 培训目标1：在预防自杀环境中获得经验设计和进行二元RCT。 培训目标2：在分析的临床试验数据中发展专业知识。 培训目标3：了解制定可实施干预措施的基本原理。