A Novel Peer-Delivered Recovery-Focused Suicide Prevention Intervention for Veterans with Serious Mental Illness

针对患有严重精神疾病的退伍军人的新型同伴交付的以康复为重点的自杀预防干预措施

• 批准号: 10536426
• 负责人: SAMANTHA CHALKER
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 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/10536426
• 关键词: Address; Advocate; Aftercare; Ambulatory Care; Area; Award; Bipolar Disorder; Caring; Clinical; Clinical Practice Guideline; Clinical Services; Clinical Trials; Cognitive; Cognitive deficits; Communities; Coping Skills; Counseling; Development; Diagnosis; Effectiveness; Elements; Evidence based practice; Exclusion; Exclusion Criteria; Feeling suicidal; Foundations; Goals; Group Therapy; Hospitalization; Impaired cognition; Interest Group; Intervention; Interview; Learning; Maps; Memory; Mental Health; Mental disorders; Mentors; Mentorship; Methodology; Mission; Modeling; Outcome; Participant; Patients; Persons; Phase; Prevention Research; Protocols documentation; Psychotic Disorders; Public Health; Quality of life; Randomized, Controlled Trials; Recommendation; Recovery; Research; Research Personnel; Risk Assessment; Safety; Services; Severities; Site; Social Functioning; Social support; Societies; Specialist; Statistical Methods; Suicide; Suicide prevention; Telephone; Training; Veterans; Woman; acceptability and feasibility; acute care; brief intervention; cognitive training; coping; design; experience; follow-up; functional independence; improved; innovation; learning strategy; military veteran; novel; peer; pilot trial; prevent; preventive intervention; primary outcome; programs; psychosocial; recruit; retention rate; satisfaction; secondary outcome; severe mental illness; skills; skills training; social; standard care; standard of care; suicidal; suicidal behavior; suicidal risk; suicide rate; tool; uptake; user centered design

Background: Suicide is a major public health concern, particularly among Veterans with serious mental illness (SMI, i.e., psychotic disorders or bipolar disorders). These Veterans have among the highest rates of suicidal ideation and behavior among U.S. and Veteran populations. Yet, an SMI diagnosis is often an exclusion criterion for suicide-focused clinical trials, and people with SMI are frequently disengaged from care, have cognitive impairments, and have limited social supports. These factors may likely impact the feasibility and usefulness of current suicide prevention interventions such as suicide safety planning – a VHA standard of care. This proposal refines and pilots SUicide Prevention by Peers Offering Recovery Tactics (SUPPORT) – the first suicide prevention intervention tailored to Veterans with SMI to improve participation in their lives and society. Significance/Innovation: Suicide prevention is a top clinical priority for VA/DoD and RR&D. This research is innovative for several reasons: 1) SMI diagnoses have frequently been excluded from suicide prevention research and this proposal seeks to tailor a novel suicide-focused intervention specifically to Veterans with SMI; 2) this proposal is one of few studies that includes Veterans with SMI to enhance safety planning, which is crucial given that it is an existing suicide prevention standard of care in VHA; 3) this proposal integrates the recovery model and best practices into suicide prevention; 4) SUPPORT is delivered by Peer Specialists, which the 2019 VA/DoD Clinical Practice Guidelines for the Assessment and Management of Patients at Risk for Suicide highlighted a priority for future research to explore “post-acute care approaches,” such as safety planning, and that such approaches could be peer-delivered; 5) this is the first intervention to integrate cognitive learning strategies in a suicide-focused intervention to accommodate cognitive impairments in SMI. Methodology: The proposed 5-year study aims to refine and pilot a peer-delivered intervention to improve functional and social recovery to decrease suicide risk; the proposal consists of two phases. Phase 1 (1.5 years) employs a user-centered design approach to refine SUPPORT aided by scientific and consumer (n=8) advisory board stakeholders as well as training our PSs to fidelity on pilot cases in an open trial (n=15) and qualitative interviews. SUPPORT is a 4-week peer-delivered intervention intended to augment safety planning by addressing functional and social goals personalized to each Veteran’s recovery following a suicidal crisis while including cognitive learning strategies to enhance recall and salience of intervention material. Following adaptations from Phase 1, Phase 2 (3.5 years) includes a pilot (n=50) randomized controlled trial (RCT) of SUPPORT compared to an enhanced standard care (ESC) condition that contains the elements of standard practice suicide prevention delivered at VHA, which include: 1) suicide risk assessment, 2) VA Safety Planning Intervention, 3) timely referral to VA mental health outpatient care, and 4) Suicide Prevention Coordinator follow-up contacts. Veteran participants in both phases will be quantitatively assessed at baseline, mid- treatment, post-treatment, and 3-months post-treatment (and qualitatively interviewed at post-treatment; Peer Specialists delivering the intervention will also be qualitatively interviewed post-treatment). The primary outcomes to be evaluated is improvement in personal recovery and reduction in suicidal ideation severity. Secondary outcomes concern changes in various domains of personal and social functioning. Next Steps: This CDA-2 is the first step toward developing a program of research within VHA focused on enhancing suicide related care by tailoring recovery-informed suicide-focused interventions to Veterans with SMI. Pending confirmation of feasibly and preliminary impact, Dr. Chalker would submit for an RR&D Merit to explore a multi-site, adequately powered RCT of SUPPORT versus ESC. We would emphasize 1) examination of moderators or groups of interest (such as women Veterans) and 2) SUPPORT mechanisms of change.

背景：自杀是一个主要的公共卫生问题，特别是在患有严重精神疾病的退伍军人中 (SMI，也就是，精神病或双相情感障碍）。这些退伍军人的自杀率最高 美国和退伍军人群体的想法和行为。然而，SMI诊断通常是一种排除， 标准的自杀为重点的临床试验，并与SMI的人经常脱离照顾， 认知障碍，社会支持有限。这些因素可能会影响可行性， 目前自杀预防干预措施的有效性，如自杀安全计划-VHA标准 在乎该提案完善和试点自杀预防同伴提供恢复策略（支持）- 第一个自杀预防干预适合退伍军人与SMI，以提高他们的生活参与， 社会 意义/创新：自杀预防是VA/DoD和RR&D的首要临床优先事项。本研究是 创新有几个原因：1）SMI诊断经常被排除在自杀预防之外 这项研究和这项建议旨在为退伍军人量身定制一种新的以自杀为重点的干预措施， SMI; 2）该提案是为数不多的研究之一，包括退伍军人与SMI，以加强安全规划， 是至关重要的，因为它是VHA现有的自杀预防护理标准; 3）这项建议整合了 恢复模式和预防自杀的最佳做法; 4）由同行专家提供支持， 2019年VA/DoD风险患者评估和管理临床实践指南 自杀组织强调了未来研究的优先事项，即探索“急性后护理方法”， 规划，这种方法可以同行交付; 5）这是第一个干预措施， 认知学习策略在自杀为重点的干预，以适应认知障碍的SMI。 方法：拟议的5年研究旨在完善和试点同行提供的干预措施，以改善 功能和社会康复，以减少自杀风险;该提案包括两个阶段。第1阶段（1.5 年）采用以用户为中心的设计方法，在科学和消费者的帮助下完善支持（n=8） 咨询委员会利益相关者以及培训我们的PS在开放试验中忠实于试点病例（n=15）， 定性访谈。支持是一项为期4周的同行提供的干预措施，旨在加强安全规划 通过解决功能和社会目标个性化每个退伍军人的恢复后，自杀危机 同时包括认知学习策略，以增强干预材料的回忆和突出性。以下 1期、2期（3.5年）的改编包括一项试点（n=50）随机对照试验（RCT）， 支持与包含标准要素的增强标准护理（ESC）条件相比 在VHA实施自杀预防，包括：1）自杀风险评估，2）VA安全计划 干预，3）及时转诊到VA心理健康门诊护理，4）自杀预防协调员 后续联系。两个阶段的资深参与者将在基线、中期和中期进行定量评估。 治疗、治疗后和治疗后3个月（并在治疗后进行定性访谈; 提供干预措施的专家也将在治疗后接受定性采访）。主 评价的结果是个人恢复的改善和自杀意念严重程度的降低。 次要结果涉及个人和社会功能各个领域的变化。 下一步：CDA-2是在VHA内制定研究计划的第一步，重点是 通过为退伍军人量身定制以自杀为重点的康复干预措施，加强与自杀相关的护理， SMI。在确认可行性和初步影响之前，Chalker博士将提交RR&D Merit， 探索支持与ESC的多中心、充分把握度RCT。我们要强调1）检查 主持人或利益集团（如妇女退伍军人）和2）支持机制的变化。