Suicide Safety Planning Group Treatment: "Project Life Force"

 描述（由申请人提供）： 尽管退伍军人事务部自杀预防服务的丰富和国家自杀热线的实施，退伍军人自杀完成已上升到每天22和自杀企图在2012年超过15,000。这些数据强调了针对自杀退伍军人制定额外干预措施的紧迫性。自杀安全计划（SSP）的建设;一个“最佳实践”，是整个VA系统的任务，也是VA在自杀预防和康复方面协调努力的重要组成部分。我们对自杀退伍军人在30天时间范围内使用SSP模式的试点数据表明，只有65%的退伍军人使用了他们的安全计划，计划上列出的应对策略往往不匹配或不足以满足个人的需求，并且在压力期间有限的SSP使用对其效用产生了负面影响。据我们所知，目前还没有推荐的指南或机制，以完善SSP在成人人群超出其初始发展。“生命力计划”（PLF）是一种新型的自杀安全规划小组干预措施，旨在填补这一关键空白，并提供一种机制，随着时间的推移，发展和加强自杀安全规划。PLF是一个12个疗程的团体心理治疗干预，结合辩证行为治疗（DBT）技能和心理教育方法，以加强自杀安全计划的制定和实施。退伍军人在几周内修改他们的计划，同时学习痛苦容忍，情绪调节和友谊建设/人际交往技能， 并接受有关枪支安全和尽量减少使用致命手段的课程。会议增加了1）培训使用自杀安全计划移动的应用程序，以促进可访问性和最大限度地实现，和2）教学信息，以支持恢复，包括促进改善与治疗团队的联系，和退伍军人的家庭。重要的是，小组形式减轻了孤独感，并促进了“幸福感”的增加，这两者都是自杀的关键风险因素。此外，PLF的每周格式有利于VA授权的监测任何退伍军人放在自杀“高风险”名单。 本项目的数据将检验干预的可行性、可接受性和初步疗效，并为更大规模的随机临床试验提供初步数据。该项目由两个阶段组成。同相 1，我们将最终确定PLF干预措施和附带的手册和讲义。在第2阶段，我们将在50名自杀退伍军人中进行PLF的开放标签试验，以评估干预的可行性和可接受性。我们还将通过检查PLF前后这些指标的临床有意义的差异来检验PLF是否影响自杀意念、抑郁、绝望和门诊依从性的结果。

 DESCRIPTION (provided by applicant): Despite the enrichment of VA suicide prevention services and implementation of the national suicide hotline, Veteran suicide completions have risen to 22 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. Our pilot data on patterns of SSP use in suicidal Veterans over a 30 day time frame demonstrates that only 65% of Veterans used their safety plans, coping strategies listed on the plan were often mismatched or inadequate to the individual's needs, and limited access to the SSP during times of stress negatively impacted its utility. 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 12-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. Sessions are augmented with 1) training in the use of a suicide safety planning mobile App to promote accessibility and maximize implementation, and 2) didactic information to bolster recovery, including fostering improved connection with the treatment team, and Veteran's family. 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. Data from this project will test the intervention's feasibility, acceptability and preliminary efficacy and provid pilot data for a larger randomized clinical trial. The project is comprised of two phases. In Phase 1, we will finalize the PLF intervention and accompanying manual and handouts. In Phase 2, we will conduct an open label trial of PLF in 50 suicidal Veterans to evaluate the feasibility and acceptability of the intervention. We will also test whether PLF affects outcomes of suicide ideation, depression, hopelessness, and outpatient compliance by examining clinically meaningful differences in these measures before and after PLF.