Development of an adjunctive video-based suicide prevention intervention immediately following psychiatric hospitalization

自杀和自杀未遂是美国的主要公共卫生问题，造成近4.5万人死亡 在2016年，每年有超过100万次尝试。迫切需要基于证据的干预-- 基于减少自杀行为的原则，并可提供给大量患者 当他们自杀风险很高的时候。在这个治疗开发项目中，我们建议开发和测试 为有自杀行为或有自杀计划的精神病患者提供基于叙事的视频干预 住院治疗。为了应对过渡期间的治疗需求，我们之前开发了一种为期6个月的 临床医生提供的面对面和电话的心理社会干预称为长期积极应对 针对精神病住院出院患者的自杀计划(CLAP)。扣环目标键 与自杀行为相关的风险因素，以减少随后的风险。在这个项目中，我们建议 在CLAP模型的基础上开发一种新的干预措施，称为LifePlans，但使用一种易于传播的 基于视频的形式，在其中真实的患者讨论他们的自杀行为和应对策略的病史。 基于之前的研究，我们认为，让有生活经验的人讲述他们自己的故事 有参与和促进行为改变的潜力。生活计划将由5，30分钟的剧集组成 突出患者与CLAP模式一致的体验：1)制定个性化的生活计划，以 保持安全和限制手段，2)明确有价值的人生领域和相关目标，以提高希望，3) 通过解决问题来应对疾病，4)改善与家人/朋友的沟通，以增加社交 支持；5)坚持门诊治疗。这项研究将分为三个阶段。在第一阶段，我们将采访 有自杀行为住院史的患者的生活经历和应对方式 历史。我们将邀请一个子集回来接受镜头采访，拍摄一系列纪录片风格的视频， 将构成终身计划的基础。在拍摄其他与临床医生相关的内容之后，并根据来自 患者和家庭咨询委员会，我们将创建5，30分钟的生命计划和陪同患者的剧集 使用叙述方法说明关键扣环原则的练习册。然后我们将进行一次公开审判 (n=10；第二阶段)和试点随机对照试验(n=40；第三阶段)，以测试住院生命计划的可行性/可接受性 有入院前自杀计划/企图的患者。患者将在基线、出院、1和6进行评估 出院后几个月的自杀行为(主要)、自杀意念、精神症状、功能、 再住院率和可能的机制。我们将检查可行性和可接受性(视频率 观看、参与、满意度、招聘/保留)。在随机对照试验中，我们将检查治疗差异 (在相关的可信区间内)结果(例如，自杀行为)，以及可能的变化 机械装置。最终，该项目将提供在全面RCT中测试LifePlans所需的数据 确定其对高危患者预防自杀的有效性和作用机制。

Suicide and attempted suicide are major public health issues in the U.S., accounting for almost 45,000 deaths in 2016, and over 1 million attempts each year. There is an urgent need for interventions based on evidence- based principles that decrease suicidal behavior and are feasible to deliver to large numbers of patients at times when their risk for suicide is high. In this treatment development project, we propose to develop and test a narrative-based video intervention for people with suicidal behavior or plan being discharged from psychiatric hospitalization. In response to the need for treatment over this transition, we previously developed a 6-month, in-person and telephone, clinician-delivered, psychosocial intervention called Coping Long Term with Active Suicide Program (CLASP) for patients being discharged from psychiatric hospitalization. CLASP targets key risk factors associated with suicidal behavior in order to reduce subsequent risk. In this project, we propose to develop a new intervention, called LifePlans, based on the CLASP model but using an easily disseminable video-based format in which real patients discuss their history of suicidal behavior and coping strategies. Based on previous research, we believe that having people with lived experience tell their own stories has the potential to be engaging and to catalyze behavior change. LifePlans will consist of 5, 30-min episodes that highlight patients’ experiences consistent with the CLASP model: 1) developing a personalized “Life Plan” to stay safe and restrict means, 2) clarifying valued life domains and related goals to improve hopefulness, 3) using problem solving to cope with illness, 4) improving communication with family/friends to increase social support, and 5) adhering to outpatient treatments. This study will have 3 phases. In phase 1, we will interview patients with a history of psychiatric hospitalization for suicidal behavior about their life experiences and coping history. We will invite a subset back to be interviewed on camera for a series of documentary-style videos that will form the basis of LifePlans. After the filming of additional clinician-related content and with feedback from a Patient and Family Advisory Council, we will create 5, 30-min episodes of LifePlans and accompanying patient workbook that illustrate key CLASP principles using narrative methods. We will then conduct an open trial (n=10; phase 2) and a pilot RCT (n=40; phase 3) to test the feasibility/acceptability of LifePlans for hospitalized patients with a pre-admission suicide plan/attempt. Patients will be assessed at baseline, discharge, 1, and 6 months post-discharge on suicidal behaviors (primary), suicidal ideation, psychiatric symptoms, functioning, rehospitalization rate, and possible mechanisms. We will examine feasibility and acceptability (rate of video viewing, engagement, satisfaction, recruitment/retention). In the RCT, we will examine treatment differences (within relevant confidence intervals) on outcomes (e.g., suicide behaviors), and change on possible mechanisms. Ultimately, this project will provide the data needed to test LifePlans in a full-scale RCT to determine its effectiveness and mechanisms of action for suicide prevention in high-risk patients.