Suicide Safety Planning Group Treatment: "Project Life Force"

 描述(由申请人提供)： 尽管丰富了退伍军人自杀预防服务，并开通了国家自杀热线，但2012年退伍军人自杀未遂人数已上升至每天22人，自杀未遂人数超过15,000人。这些数据强调了针对有自杀倾向的退伍军人开发更多干预措施的紧迫性。构建自杀安全计划(SSP)；这是整个退伍军人管理局系统强制要求的“最佳做法”，也是退伍军人管理局预防和康复自杀的协调努力的重要组成部分。我们关于自杀退伍军人在30天内使用SSP模式的试点数据显示，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经常不匹配或不足以满足个人的需求，在压力时期有限地获得SSP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来完善成年人群中SSP的初步发展。“生命力计划”(PLF)是一种新的自杀安全计划团体干预措施，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计划。PLF是一个为期12个疗程的团体心理治疗干预，结合了基于辩证行为治疗(DBT)技能和心理教育的方法，以加强自杀安全规划的制定和实施。退伍军人在几周的时间里修改他们的计划，同时学习承受痛苦、情绪调节和建立友谊/人际关系的技能，以纳入 在他们的安全计划中，并接受关于枪支安全和最大限度地减少使用致命手段的课程。课程的补充包括：1)培训自杀安全规划移动应用程序的使用，以促进可获得性和最大限度地实施；2)教学信息，以支持康复，包括促进与治疗团队和退伍军人家属的改善联系。重要的是，团队形式减轻了孤独感，培养了更多的“归属感”，这两个因素都是自杀的关键风险因素。此外，PLF的每周格式便于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测。该项目的数据将测试干预的可行性、可接受性和初步疗效，并为更大规模的随机临床试验提供先导数据。该项目由两个阶段组成。同相 1，我们将最终确定PLF干预以及随附的手册和讲义。在第二阶段，我们将在50名有自杀倾向的退伍军人中进行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意义差异来测试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.