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.

浪漫关系困扰是患有抑郁症的退伍军人中常见的障碍， 一项针对退伍军人进行筛查的研究显示，创伤后应激障碍 (PTSD)、滥用酒精和自杀风险。 58% 的有伴侣的退伍军人报告了恋爱关系，对初级保健中的上述问题持积极态度 人际关系问题也是自杀的一个重要风险因素，占退伍军人自杀率的 24%。 死亡和 18-35 岁退伍军人离线关系的 50%，充分参与相互支持的授予。 这表明我们可以通过将不良关系转变为自杀来抵消风险。 不幸的是，现有夫妻疗法的强化形式导致了夫妻之间的保护性伙伴关系。 2-3 次治疗后停止治疗或推迟治疗直至接近分手，这强调了这种必要性。 获取可通过初级保健心理健康 (PC-MHI) 获得的简短关系支持。 简短关系检查 (BRC) 是一项为期 30 分钟的三场会话干预，旨在解决人际关系问题 BRC 结合了夫妻疗法和动机访谈技术来缓解困扰。 BRC 鼓励夫妻做出具体承诺，以改善他们的关系。 减少自杀危险因素，例如人际关系功能障碍，并促进保护性因素，例如相互关系 对彼此关切的回应，这是支持性关系的核心要素。 还被证明可以增加个人和夫妻治疗的参与度并减少抑郁症状。 在开放标签试点试验中，我们发现 BRC 对于 VHA 筛查呈阳性的退伍军人来说是可行且可接受的 我们还发现学员可以学习其高度结构化的框架。 没有先前的夫妻治疗经验。 研究计划：我们建议对 72 对夫妇进行 BRC 试验随机对照试验 (RCT)，以 评估其改变自杀风险/保护因素的能力，将通过电话筛选参与者以识别。 处于痛苦的忠诚关系中的夫妇，其中至少一个伴侣是退伍军人（“目标 退伍军人”）在初级保健心理健康筛查中对常见自杀危险因素（即， 我们将把夫妇随机分配到 BRC 或三个疗程。 当前的 PC-MHI 协同护理模式 (CCC) 仅适用于退伍军人合作伙伴所有参与者。 将完成基线、治疗后、3 个月和 6 个月的评估。该研究将提供以下结果。 通过追求以下研究目标和假设，为更大规模的临床试验提案奠定基础 (H)： 目标 1：确定 BRC 在改善伴侣双方与自杀相关的关系因素方面的功效。 H1a. BRC 中的夫妇会比 CCC 中的夫妇报告关系功能障碍的减少更多。 H1b. BRC 中的夫妇比 CCC 中的夫妇报告的相互反应性增加更大。 目标 2：确定 BRC 在改善目标退伍军人与自杀相关的个人因素方面的功效。 H2a. BRC 中的目标退伍军人将通过图表审查显示出比 CCC 中的目标退伍军人更高的治疗利用率。 子目标 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（即抑郁症、创伤后应激障碍（PTSD）和酗酒）。 子目标 2c：探索风险因素变化与退伍军人自杀意念变化之间的关联。 目标 3：开发并验证保真度密码本，以实施 BRC 依从性和临床医生能力。 职业规划：Crasta 博士将利用上述每个研究目标作为追求的机会 根据预防科学框架选择的补充培训目标： 培训目标 1：获得在自杀预防背景下设计和开展二元随机对照试验的经验。 培训目标 2：培养分析临床试验数据的专业知识。 培训目标 3：了解制定可实施干预措施的基础知识。