Group (“Project Life Force”) vs. Individual Suicide Safety Planning RCT

尽管丰富了退伍军人自杀预防服务，并实施了国家 自杀热线，老兵每天自杀20次，自杀未遂 2012年，这一数字超过了15,000。这些数据突显了开发更多 针对有自杀倾向的退伍军人的干预。构建自杀安全计划(SSP)； “最佳实践”是整个退伍军人制度的要求，也是退伍军人制度的重要组成部分。 协调努力预防自杀和康复。退伍军人演示中的安全计划 急诊室被证明可以减少自杀行为。据我们所知，有 目前还没有推荐的指南或机制来完善成人的SSP 人口数量超过了最初的发展阶段。“生命力计划”(PLF)--一种新的自杀安全 计划小组干预旨在填补这一关键空白，并提供一种机制 随着时间的推移，制定和加强自杀安全规划。PLF，一个10节课的小组 心理治疗干预，结合辩证行为治疗(DBT)技能和 心理教育方法，以加强自杀安全规划的制定和 实施。退伍军人在学习困难期间在几周内修改他们的计划 宽容、情绪调节和友谊建立/人际交往技能，以融入他们的 制定安全计划，并接受有关枪支安全和最大限度减少使用致命手段的课程， 增进身体健康和策略如何与家人/重要人士分享他们的计划 其他人和他们的治疗团队。重要的是，小组形式减轻了孤独感，培养了 增加“归属感”，这两个因素都是自杀的关键风险因素。此外，PLF的每周格式 协助退伍军人管理局对任何被列入自杀“高危”名单的退伍军人进行监控。PLF 2015年从退伍军人康复和研究开发中心获得试点尖顶资金，以 最后完成干预手册的开发，并在退伍军人中试点干预。 初步数据表明，这种做法具有很高的可行性和可接受性。100%的参与者 制定了更新的安全计划，增加了使用模式，并显著减少了 自杀念头。 该项目的目标是进行多站点(詹姆斯J彼得斯VAMC和费城，弗吉尼亚州) PLF与常规治疗(TAU)的随机临床试验(RCT)，包括个体 电话回顾265名有自杀倾向的退伍军人的安全计划，并随访一年。这个 主要结果变量是自杀行为，使用严格的、多方法评估 后续行动。次要结果包括抑郁、绝望和治疗利用率。 探索性分析将考察自杀应对和群体水平的变化 PLF中的凝聚力介导了治疗反应。方法的严格性包括持续的坚持 由独立的第三个站点(哥伦比亚)对PLF和评估培训/监测进行评级 大学)。

Despite the enrichment of VA suicide prevention services and implementation of the national suicide hotline, Veteran suicide completions occur 20 times per day and suicide attempts numbered over 15,000 in 2012. These data underscore the urgency of developing additional interventions targeting suicidal Veterans. The construction of a Suicide Safety Plan (SSP); a “best practice,” is mandated throughout the VA system, and a vital component of the VA’s coordinated effort at suicide prevention and recovery. Safety Planning in Veterans presenting to an emergency room has been shown to decrease suicide behavior. To our knowledge, there are currently no recommended guidelines or mechanisms for refinement of the SSP in adult populations beyond its initial development. “Project Life Force” (PLF), a novel suicide safety planning group intervention has been designed to fill this critical gap and provide a mechanism to develop and enhance suicide safety planning over time. PLF, a 10-session, group psychotherapy intervention, combines Dialectical Behavioral Therapy (DBT) skill based and psychoeducational approaches, to enhance suicide safety planning development and implementation. Veterans revise their plans over several weeks while learning distress tolerance, emotion regulation, and friendship building/interpersonal skills to incorporate into their safety plans and also receive lessons on gun safety and minimizing access to lethal means, augmenting physical well being and strategies how to share their plan with family/significant others and their treatment team. Importantly, the group format mitigates loneliness and fosters increased “belongingness,” both key risk factors for suicide. Additionally, PLF’s weekly format facilitates VA-mandated monitoring for any Veteran placed on the suicide “high risk” list. PLF received pilot SPiRE funding from the VA Rehabilitation and Research Development in 2015 to finalize the development of the intervention’s manual and pilot the intervention in Veterans. Preliminary data suggests high levels of feasibility, and acceptability. 100% of participants developed updated safety plans and increased use patterns and a significant decrease in suicidal ideation. This project’s aim is to conduct a multi-site (James J Peters VAMC and Philadelphia VA) randomized clinical trial (RCT) of PLF versus treatment as usual (TAU) that includes individual telephone review of safety plans in 265 suicidal Veterans with follow up to one year. The primary outcome variable is suicidal behavior, using a rigorous, multi-method assessments follow-up. Secondary outcomes include depression, hopelessness and treatment utilization. Exploratory analyzes will examine whether changes in suicide coping and levels of group cohesion in PLF mediate treatment response. Methodological rigor includes ongoing adherence ratings for PLF and assessment training/monitoring by an independent third site (Columbia University).