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，导致近45,000人死亡 在2016年，每年超过100万次尝试。迫切需要基于证据的干预措施- 基于减少自杀行为的原则，并可在 当他们自杀的风险很高时。在这个治疗开发项目中，我们建议开发和测试 对有自杀行为或计划从精神科出院的人进行基于叙述的视频干预 住院为了应对这一过渡期的治疗需求，我们之前开发了一种为期6个月， 面对面和电话，临床医生提供，心理社会干预，称为应对长期与积极 自杀计划（CLASP），针对从精神病院出院的患者。CLASP目标键 与自杀行为相关的风险因素，以降低随后的风险。在这个项目中，我们建议 开发一种新的干预措施，称为生活计划，基于CLASP模型，但使用易于传播的 基于视频的格式，其中真实的患者讨论他们的自杀行为和应对策略的历史。 根据以前的研究，我们认为，让有生活经验的人讲述自己的故事， 参与和催化行为改变的潜力。生活计划将包括5个，30分钟的插曲， 强调患者的经验与CLASP模型一致：1）制定个性化的“生活计划”， 保持安全和限制手段，2）澄清有价值的生活领域和相关目标，以提高幸福感，3） 用解决问题的方法来科普疾病，4）改善与家人/朋友的沟通，以增加社会 支持，和5）坚持门诊治疗。本研究将分为3个阶段。在第一阶段，我们将采访 对有自杀行为住院史的精神科患者的生活经历和应对方式进行调查 历史我们将邀请一部分人回来接受一系列纪录片式视频的采访， 将成为人生计划的基础。在拍摄了额外的临床医生相关内容后， 患者和家庭咨询理事会，我们将创建5个，30分钟的生活计划和陪同患者集 使用叙述方法说明CLASP关键原则的工作簿。我们将进行公开审判 （n=10; 2期）和一项试点RCT（n=40; 3期），以测试LifePlans用于住院患者的可行性/可接受性 入院前有自杀计划/企图的患者。将在基线、出院、1和6时对患者进行评估 出院后3个月自杀行为（原发性）、自杀意念、精神症状、功能， 再住院率和可能的机制。我们将研究可行性和可接受性（视频率 观看、参与、满意度、招聘/保留）。在RCT中，我们将检查治疗差异 （在相关置信区间内）对结果的影响（例如，自杀行为），并改变可能的 机制等最终，该项目将提供在全面RCT中测试LifePlans所需的数据， 确定其预防高危患者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.