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

背景：尽管退伍军人事务部(VA)努力实施一揽子自杀计划 在预防战略方面，自杀在退伍军人中仍然是一个持续存在的问题，特别是在 在精神科住院后的几个月。[目前的证据表明，一些最重要的 住院后自杀风险的促成因素包括较差的社会联系和参与 出院后的护理。作为回应，我们开发了一种很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(和平)，结合了 移动健康(MHealth)技术，通过基于手动的干预来提高连接性和 全身心投入到护理中。我们的试点数据表明，基于人工的方法来提高护理参与度 在减少自杀风险方面有很大的希望，但可以通过增加mHealth来进一步增强 增加社会联系的战略。因此，下一步适当的步骤是在 以澄清将这两种方法结合在一起是否是有效的自杀预防战略。] 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。她的全套服装 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 开始她的独立临床研究事业所需的经验。她的短期目标是获得 所需技能：[(1)设计和调整临床干预措施；(2)设计、实施和管理 临床试验]；和(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[和平]在减少 精神病住院后的自杀风险。她的中心假设是[和平]加标准 精神病院出院护理[(TAU)]导致精神病患者术后自杀意念的更大减少 住院与单独[TAU]相比。第二个假设是[和平]发挥了它的反自杀作用。 通过[改善社会连通性和护理参与度。]她将在 获奖期的最后两年。如果这项建议的结果是积极的，Riblet博士的功绩奖励建议 将重点对[和平]进行多点试验，进一步完善[和平]，和/或 开发一种替代干预措施，更好地应对自杀风险。 方法：将在有精神疾病的退伍军人中进行一项随机对照试验。 在[怀特河交界处退伍军人医疗中心]住院。符合条件的患者将在一段时间内被招募 四年，将被随机分配到[和平加TAU或单独TAU]。患者将接受一段时间的跟踪调查 六个月。结果数据将在基线以及一个月、三个月和六个月的随访时间收集 积分。将使用广义线性混合模型来确定[和平]是否导致显著 自杀意念的改善。结构方程模型将被用来确定社会 关爱的连通性和参与度缓和了[和平]对自杀念头的影响。探索性的 将使用事件发生时间分析进行分析，以确定[和平]对自杀企图的影响。 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 自杀预防领域的临床研究人员。这项为期五年的奖项将包括教育、研究、 和导师关系的组成部分。教育部分将为Riblet博士提供额外的技能 熟练地对自杀风险较高的退伍军人进行临床研究。研究的组成部分 将使Riblet博士在进行自杀预防策略的临床试验时掌握切实的技能，以及这些 这些数据将被用来通知未来的优异奖。Riblet博士还将受益于以下项目的专家指导 自杀预防和临床研究领域的领先者。

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.