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

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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.