Beyond maintaining safety: Examining the benefit of emotion-centered problem solving therapy added to safety planning for reducing late life suicide risk.
Beyond maintaining safety: Examining the benefit of emotion-centered problem solving therapy added to safety planning for reducing late life suicide risk.
复制标题
除了维持安全之外：检查以情绪为中心的问题解决疗法添加到安全计划中以降低晚年自杀风险的好处。
DOI：
10.1016/j.cct.2023.107147
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发表时间：
2023
影响因子：
2.2
通讯作者：
Fun
中科院分区：
文献类型：
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作者：
Beaudreau,SherryA;Lutz,Julie;Wetherell,JulieLoebach;Nezu,ArthurM;Nezu,ChristineMaguth;O'Hara,Ruth;Gould,ChristineE;Roelk,Brandi;Jo,Booil;Hernandez,Beatriz;Samarina,Viktoriya;Otero,MarcelaC;Gallagher,Alana;Hirsch,James;Fun
很少有临床试验研究了用于降低老年退伍军人自杀风险的简单非药物治疗，这是一个高风险群体。问题解决疗法（PST）是一种很有前途的心理社会干预，通过有效的问题解决和相关的应对技能来增加对问题的适应性应对，从而降低晚年自杀风险。目前的随机临床试验将比较6次电话传递的安全计划（增强型常规护理; EUC）或更新版本的PST（以情绪为中心的PST [EC-PST]）+ EUC的疗效，以确定EC-PST在降低自杀意念严重程度和增加生存理由（一个关键的保护因素）方面的额外临床获益。随机分配至EC-PST + EUC或仅EUC组的受试者将为150名有主动自杀意念的退伍军人（各75名），年龄≥ 60岁;目前患有DSM-5焦虑、抑郁和/或创伤相关疾病;无显著认知障碍。将在11个时间点评估主要结局（老年自杀意念量表和老年人生存原因量表）：基线、6次治疗后、治疗后和治疗后1个月、3个月和6个月的随访，并使用混合效应模型进行分析。此外，主要结局的调节者和中介者将被检查功能障碍、执行功能障碍和解决问题的能力。参与者的定性反馈将确定EC-PST方案和EUC的潜在以退伍军人为中心的变更。最终，本研究的目标是为降低老年退伍军人自杀风险的治疗提供循证临床实践指南，特别是为临床决策提供关于将EC-PST添加到EUC的优点的信息。
Few clinical trials have examined brief non-pharmacological treatments for reducing suicide risk in older Veterans, a high-risk group. Problem Solving Therapy (PST) is a promising psychosocial intervention for reducing late life suicide risk by increasing adaptive coping to problems through effective problem solving and related coping skills. The current randomized clinical trial will compare the efficacy of six telephone-delivered sessions of Safety Planning (enhanced usual care; EUC) only or an updated version of PST (emotion-centered PST [EC-PST]) + EUC to determine the added clinical benefit of EC-PST for reducing severity of suicidal ideation and for increasing reasons for living, a critical protective factor. Participants randomized to EC-PST + EUC or EUC only will be 150 Veterans (75 each) with active suicidal ideation who are aged 60 or older; have a current DSM-5 anxiety, depressive, and/or trauma-related disorder; and without significant cognitive impairment. Primary outcomes (Geriatric Suicide Ideation Scale and Reasons for Living-Older Adults scale) will be assessed at 11 timepoints: baseline, after each of 6 treatment sessions, posttreatment, and at follow-up at 1, 3, and 6 months posttreatment, and analyzed using mixed effects modeling. Additionally, moderators and mediators of primary outcomes will be examined—functional disability, executive dysfunction, and problem-solving ability. Qualitative feedback from participants will identify potential Veteran-centric changes to the EC-PST protocol and to EUC. Ultimately, the goal of this study is to inform the evidence-based clinical practice guidelines for treatments to reduce suicide risk in older Veterans and specifically to inform clinical decision-making regarding the merit of adding EC-PST to EUC.