Prevention of Suicide in Veterans Through Brief Intervention and Contact (VA-BIC)

背景：尽管退伍军人事务部（VA）努力实施自杀一揽子计划 预防策略，自杀仍然是退伍军人中持续存在的问题，特别是在三 精神病院住院几个月后。 [目前的证据表明，一些最重要的 住院后自杀风险的影响因素包括社交联系和参与度差 出院后的护理。作为回应，我们制定了一项有前途的自杀预防策略，称为 预防自杀：教育、意识、联系和参与 (PEACE)，它结合了 移动医疗 (mHealth) 技术，通过手动干预来增强连通性和 参与护理。我们的试点数据表明，采用基于手动的方法来提高护理参与度 在降低自杀风险方面前景广阔，但可以通过增加移动医疗来进一步增强 增加社会联系的策略。因此，下一步适当的步骤是进行临床试验 为了澄清将这两种方法结合在一起是否是一种有效的自杀预防策略。] 目标： 候选人 Natalie Riblet 博士的长期目标是成为一名独立的临床医生 研究人员专注于开发、测试和改进预防自杀的干预措施。她的整体 这个五年职业发展计划的目标是获得教育、指导和研究 开展独立临床研究职业所需的经验。她的短期目标是获得 必要的技能：[(1) 设计和调整临床干预措施； (2) 设计、实施和管理 临床试验]； (3) 对自杀高危患者进行临床研究。她的研究目标 与这些目标保持一致。 Riblet 博士提出的研究项目测试了 [PEACE] 在减少 精神病院住院后的自杀风险。她的中心假设是[和平]加上标准 精神病院出院护理[(TAU)]可大大减少精神病院出院后的自杀意念 与单独[TAU]相比住院治疗。第二个假设是[PEACE]发挥其抗自杀作用 通过[改善社会联系和护理参与。]她将在 奖励期的最后两年。如果该提案的结果是积极的，Riblet 博士的优异奖提案 将重点开展 [PEACE] 的多站点试验，进一步改进 [PEACE]，和/或 制定更好地解决自杀风险的替代干预措施。 方法：[PEACE] 的随机对照试验将在患有精神病的退伍军人中进行 在 [White River Junction VA 医疗中心住院。] 符合条件的患者将在一段时间内被招募 四年，并将被随机分配至 [PEACE 加 TAU 或单独 TAU]。患者将被随访一段时间 六个月。结果数据将在基线以及一、三和六个月的随访时间收集 点。将使用广义线性混合模型来确定[和平]是否会导致显着的结果 自杀意念的改善。结构方程模型将用于确定社会是否 连通性和参与护理可调节[和平]对自杀意念的影响。一个探索性的 将使用事件时间分析来进行分析，以确定 [PEACE] 对自杀未遂的影响。 影响：拟议的职业发展奖的目标是帮助 Riblet 博士成为一名独立的人 自杀预防领域的临床研究员。这个为期五年的奖项将包括教育、研究、 和指导组成部分。教育部分将为 Riblet 博士提供额外的技能 熟练地对自杀高危退伍军人进行临床研究。研究组成部分 将为 Riblet 博士提供进行自杀预防策略临床试验的实际技能，以及这些 数据将用于为未来的优异奖提供信息。 Riblet 博士还将受益于以下专家的指导： 自杀预防和临床研究的领导者。

BACKGROUND: Despite work by the Department of Veterans Affairs (VA) to implement a package of suicide prevention strategies, suicide remains an ongoing problem among Veterans, particularly during the three months following psychiatric hospitalization. [Current evidence suggests that some of the most important contributing factors to post-hospitalization suicide risk include poor social connectedness and engagement in care in the post-discharge period. In response, we developed a promising suicide prevention strategy called Prevention of suicide: Education, Awareness, Connection, and Engagement (PEACE), which combines a mobile health (mHealth) technology with a manual-based intervention to increase connectedness and engagement in care. Our pilot data suggest that a manual-based approach to improving engagement in care holds great promise in mitigating suicide risk, but could be further enhanced through the addition of a mHealth strategy to increase social connectedness. Therefore, the next appropriate step is to perform a clinical trial in order to clarify whether combining these two approaches together is an effective suicide prevention strategy.] OBJECTIVES: The long-term goal is for the candidate, Dr. Natalie Riblet, to become an independent clinical researcher focused on developing, testing, and improving interventions to prevent suicide. Her overall objective for this five-year career development program is to gain the education, mentorship, and research experience needed to launch her independent clinical research career. Her short-term goal is to obtain the necessary skills in: [(1) designing and adapting clinical interventions; (2) designing, conducting, and managing clinical trials]; and (3) performing clinical research in patients at high risk for suicide. Her research objectives align with these goals. Dr. Riblet’s proposed research project tests the efficacy of [PEACE] in decreasing suicide risk following psychiatric hospitalization. Her central hypothesis is that [PEACE] plus standard psychiatric hospital discharge care [(TAU)] leads to a greater reduction in suicidal ideation after psychiatric hospitalization compared to [TAU] alone. A secondary hypothesis is that [PEACE] exerts its anti-suicidal effect by [improving social connectedness and engagement in care.] She will submit a merit award proposal in the last two years of the award period. If the results of this proposal are positive, Dr. Riblet’s merit award proposal will focus on conducting a multi-site trial of [PEACE], making further improvements to [PEACE], and/or developing an alternative intervention that better addresses suicide risk. METHODS: A randomized controlled trial of [PEACE] will be carried out in Veterans who are psychiatrically hospitalized at the [White River Junction VA Medical Center.] Eligible patients will be recruited over a period of four years and will be randomized to [PEACE plus TAU or TAU alone.] Patients will be followed for a period of six months. Outcome data will be collected at baseline and at one-, three-, and six-month follow-up time points. A generalized linear mixed model will be used to determine whether [PEACE] leads to significant improvements in suicidal ideation. A structural equation model will be used to determine whether social connectedness and engagement in care moderates the effect of [PEACE] on suicidal ideation. An exploratory analysis will be conducted using time-to-event analysis to determine the effect of [PEACE] on suicide attempts. IMPACT: The goal of the proposed career development award is to help Dr. Riblet become an independent clinical researcher in the field of suicide prevention. This five-year award will consist of educational, research, and mentorship components. The education components will provide Dr. Riblet with additional skills to become skilled in conducting clinical research in Veterans at high risk for suicide. The research components will equip Dr. Riblet with tangible skills in conducting a clinical trial of a suicide prevention strategy and these data will be used to inform a future merit award. Dr. Riblet will also benefit from expert mentorship from leaders in suicide prevention and clinical research.