Improving Outcomes in Suicidal Veterans with Schizophrenia

描述（由申请人提供）：

DESCRIPTION (provided by applicant): Suicide is a serious public health problem among Veterans with schizophrenia. Risk for suicidal behavior is elevated among this group of Veterans when they are discharged from the hospital following an admission for suicidal behavior. Many Veterans with schizophrenia have difficulty monitoring their symptoms and adhering to outpatient treatment. Cognitive deficits associated with the illness likely play a role, and individuals who are isolated with limited social support are particularly vulnerable. This inability to self-monitor can lead to escalating symptoms and the potential tragic outcome of suicidal behavior and even possibly premature death. To address this problem, we have designed and piloted a home-based telehealth system using the Health Buddy(R) monitoring device for Veterans with schizophrenia who have been recently hospitalized for suicidality. Our intervention is targeted for the critical transition from inpatient to outpatient care. In pilot work, our research team has been able to help patients better monitor their symptoms and improve outcomes. In comparison to a control group, our group with the telehealth monitoring has experienced a more rapid improvement in suicidal and depressive symptoms. However, we have noted some problems which need to be addressed before initiating a randomized controlled trial: (1) Some Veterans have not been able to set up the system; and (2) some Veterans who have been able to start using the system have not done so in a consistent and sustained manner. This Health Services Research and Development Pilot proposal brings together a team with expertise in key content and methodological areas (e.g., schizophrenia, telehealth interventions, health services implementation research) to identify barriers to optimize the intervention for broader implementation and testing. We plan to enhance the system for ease of Veteran use with the help of an expert panel of academic and consumer leaders. Our panel members have expertise in suicidology, recovery, substance use disorders and early warning signs of relapse, as well as in telehealth, and health services. We will then field test the enhanced telehealth system at the VA Pittsburgh Healthcare System (VAPHS) where rates of suicide are high in this Veteran population. Our overarching aim is to enhance, implement, and test the Health Buddy(R) telehealth system in order to improve the outcomes of Veterans with schizophrenia and suicidality. The specific aims for this pilot project are to: (1) evaluate and refine the telehealth system with the help of a panel of experts to optimize the utility of the intervention; and (2) field test the refined system in a group of eligible Veterans at risk for suicide. With our field test, we will administer the intervention for a 3 month period to 15 Veterans recently discharged after admission for escalating suicidal behavior. With this pilot project, we will establish project feasibility, test and refine study procedures, and obtain preliminary data for effect size and power calculations for the full scale randomized clinical trial to follow.