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: 10038807
• 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/10038807
• 关键词: Accident and Emergency department; Adherence; Adult; Aftercare; Age; Ambulatory Care; Behavior Therapy; Caring; Cognitive Therapy; Combined Modality Therapy; Communities; 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VA自杀预防服务充实并实施了国家 自杀热线，退伍军人自杀完成每天发生20次和自杀未遂 2012年编号超过15,000。这些数据强调了开发额外的紧迫性 针对自杀退伍军人的干预措施。自杀安全计划（SSP）的构建； 在整个VA系统中，要求“最佳实践”，也是VA的重要组成部分 在预防自杀和康复方面进行了协调的努力。退伍军人的安全规划向 已显示急诊室可减少自杀行为。据我们所知，有 目前尚无针对成人SSP改进的指南或机制 人口超出了其最初的发展。 “项目生命力”（PLF），一种新颖的自杀安全性 规划小组干预旨在填补这一关键空白并提供机制 随着时间的流逝，制定和增强自杀安全计划。 PLF，10条，小组 心理治疗干预措施结合了基于辩证法行为疗法（DBT）技能和 心理教育方法，以增强自杀安全计划的发展和 执行。退伍军人在学习困扰的同时修改了他们的计划 宽容，情感调节和友谊建立/人际交往能力，以纳入他们的 安全计划，还获得有关枪支安全的课程，并最大程度地减少获得致命手段的机会， 增强身体健康和策略如何与家庭/重要 其他人及其治疗团队。重要的是，小组格式减轻孤独感和养育者 增加了“归属感”，这是自杀的两个关键风险因素。此外，PLF的每周格式 促进对自杀“高风险”名单上的任何退伍军人的监控。 plf 2015年从VA康复和研究开发中获得了飞行员尖顶资金 最终确定干预手册的开发，并试用退伍军人干预。 初步数据表明可行性和可接受性很高。 100％的参与者 制定了更新的安全计划和增加的使用模式，并大大减少 自杀的想法。 该项目的目的是进行多站点（James J Peters VAMC和Philadelphia VA） PLF的随机临床试验（RCT）与往常一样（TAU）（包括个体） 265名自杀退伍军人的安全计划的电话审查，随访长达一年。这 主要结果变量是自杀行为，使用严格的多方法评估 后续。次要结果包括抑郁，绝望和治疗利用。 探索性分析将检查自杀应对的变化和群体水平是否 PLF的内聚力介导治疗反应。方法论严格包括持续的依从性 独立第三站点的PLF和评估培训/监测评级（哥伦比亚 大学）。