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

通过短暂干预和接触预防退伍军人自杀 (VA-BIC)

• 批准号: 10316148
• 负责人: Natalie Riblet
• 金额: --
• 依托单位: WHITE RIVER JUNCTION VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2025-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10316148
• 关键词: Address; Award; Awareness; Caring; Clinical; Clinical Management; Clinical Research; Clinical Trials; Coupling; Data; Education; Equation; Event; Feeling suicidal; Future; Goals; Health; Health Technology; Healthcare Systems; Hospitalization; Hospitals; Intervention; K-Series Research Career Programs; Knowledge; Learning; Manuals; Medical center; Mentorship; Mobile Health Application; Modeling; Outcome; Patients; Personal Satisfaction; Phase; Prevention Research; Prevention strategy; Program Development; Psychiatric Hospitals; Randomized; Randomized Controlled Trials; Research; Research Personnel; Research Project Grants; Risk Factors; Rivers; Site; Suicide; Suicide attempt; Suicide prevention; Testing; Time; United States Department of Veterans Affairs; Veterans; Work; World Health Organization; base; brief intervention; career; career development; design; efficacy study; efficacy testing; experience; follow-up; high risk; improved; insight; interest; intervention effect; mHealth; military veteran; multi-site trial; novel; patient engagement; programs; recruit; response; skills; social; standard care; suicidal; suicidal morbidity; suicidal risk; time use

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.

背景：尽管退伍军人事务部（VA）实施了一揽子自杀计划， 预防策略，自杀仍然是退伍军人中的一个持续存在的问题，特别是在三个 精神病住院治疗后数月。[目前的证据表明，一些最重要的 导致住院后自杀风险的因素包括社会联系不良和参与 出院后的护理。作为回应，我们开发了一种有希望的自杀预防策略， 预防自杀：教育，意识，连接和参与（和平），它结合了一个 移动的健康（mHealth）技术与人工干预，以增加连通性， 参与护理。我们的试点数据表明，一个基于手册的方法，以提高参与护理 在降低自杀风险方面有很大的希望，但可以通过增加mHealth来进一步加强 加强社会联系的战略。因此，下一个适当的步骤是进行临床试验， 以澄清这两种方法结合在一起是否是一种有效的自杀预防策略。 候选人：长期目标是候选人娜塔莉·里布利特博士成为一名独立的临床医生。 研究人员专注于开发，测试和改善预防自杀的干预措施。她的整体 这个为期五年的职业发展计划的目标是获得教育，指导和研究 她的独立临床研究生涯所需的经验。她的短期目标是获得 在以下方面的必要技能：[（1）设计和调整临床干预措施;（2）设计，实施和管理 临床试验];及（3）对自杀风险高的病人进行临床研究。她的研究目标 配合这些目标。Riblet博士提出的研究项目测试了[PEACE]在减少 精神病住院后的自杀风险。她的中心假设是[和平]加上标准 精神病出院护理[（TAU）]导致精神病治疗后自杀意念的减少 与[TAU]单独相比，住院治疗。第二个假设是，[和平]发挥其抗自杀作用 通过[改善社会联系和参与护理。]她将于 奖励期的最后两年。如果这个提案的结果是积极的，里布利特博士的优秀奖提案 将专注于进行[PEACE]的多中心试验，进一步改进[PEACE]，和/或 开发替代干预措施，更好地解决自杀风险。 方法：[PEACE]随机对照试验将在精神病退伍军人中进行 在[白河交汇处退伍军人医疗中心]住院将在以下时间段内招募合格患者 四年，将随机分配至[PEACE + TAU或TAU单药治疗]。将对患者进行随访， 六个月将在基线和1个月、3个月和6个月随访时收集结局数据 点广义线性混合模型将用于确定[PEACE]是否导致显著的 自杀意念的改善。一个结构方程模型将被用来确定是否社会 连通性和参与护理会缓和[PEACE]对自杀念头的影响。探索性 将使用至事件发生时间分析进行分析，以确定[PEACE]对自杀企图的影响。 影响：拟议的职业发展奖的目标是帮助博士。 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， 和指导的组成部分。教育部分将为里布利特博士提供额外的技能， 熟练地在自杀高危退伍军人中进行临床研究。研究组成部分 将为里布利特博士提供进行自杀预防策略临床试验的切实技能， 这些数据将用于为未来的优异奖提供信息。里布利特博士还将受益于专家指导， 自杀预防和临床研究的领导者。