Motivational Interviewing to Address Suicidal Ideation: A Randomized Controlled Trial with Suicidal Veterans

解决自杀意念的动机访谈：针对有自杀倾向的退伍军人的随机对照试验

• 批准号: 10670675
• 负责人: PETER C BRITTON
• 金额: --
• 依托单位: VETERANS AFFAIRS, UNITED STATES DEPARTMENT OF
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10670675
• 关键词: Acute; Address; Complement; Development; Feeling suicidal; Hospitalization; Hotlines; Hour; Intervention; Mediating; Medical center; Mental Health Services; Mental disorders; Modeling; Motivation; Participant; Patients; Persons; Population; Prevention strategy; Prevention trial; Psychiatric Diagnosis; Randomized; Randomized, Controlled Trials; Recording of previous events; Reporting; Research; Risk; Risk Assessment; Risk Reduction; Safety; Sampling; Severities; Suicide; Suicide attempt; Suicide prevention; Telephone; Testing; Veterans; Veterans Health Administration; Work; brief intervention; care coordination; efficacy evaluation; experience; follow up assessment; follow-up; high risk; innovation; motivational enhancement therapy; novel; programs; recruit; reducing suicide; response; suicidal; suicidal behavior; suicidal risk; suicide rate; telephone session; treatment as usual; trial comparing

Veterans Health Administration (VHA) has long known that Veterans who have recently had a suicidal crisis such as those in acute psychiatric hospitalization are at increased risk for suicide. In response, VHA developed a suicide prevention strategy and enhanced usual care (EUC) for high-risk Veterans by adding care coordination, safety plans, and access to a 24-hour crisis hotline. There has also been a broad array of innovative suicide prevention trials across VHA. However, the only intervention that has shown promise in reducing risk for suicide attempts in Veterans is Safety Planning, that has already been implemented across VHA. Despite these efforts, suicide rates following such crises have plateaued and there has been no observable reduction in risk in this population, requiring the development and testing of additional strategies that complement these already implemented approaches. Research suggests that treatments to reduce suicidal behavior may need to focus on both the motivation to live and the motivation to die to obtain optimal effects. The PI developed a revised version of Motivational Interviewing to Address Suicidal Ideation (MI-SI-R) to help Veterans resolve ambivalence about living by increasing the motivation to live, that is delivered as one-to-two in-person sessions with a telephone booster session. In a preliminary randomized controlled trial (RCT) in psychiatrically hospitalized Veterans, MI-SI-R plus EUC was associated with 50% fewer suicide attempts and 41% lower likelihood of suicidal ideation compared to EUC alone. Furthermore, post-hoc analyses suggested that MI-SI-R had a stronger impact on suicide attempt risk among those with an attempt history, but a stronger impact on suicidal ideation among those without a suicide attempt history, which requires replication. Additional research is also needed to deepen our understanding of MI-SI-R and its hypothesized mechanistic model by examining its efficacy among patients with different psychiatric disorders and its putative motivational mechanisms. We are proposing an RCT comparing MI-SI-R plus EUC (MI-SI-R+EUC) to EUC alone in a sample of 470 high- risk Veterans with recent suicidal crises from three VHA Medical Centers, with “high-risk” defined as a suicide attempt within a month or suicidal ideation > 5 on the Beck Scale for Suicidal Ideation. Half (n = 235) will be randomized to MI-SI-R+EUC (three sessions in-person, via Video Connect, or telephone) and the remaining participants (n = 235) will receive EUC alone. All participants will be asked to complete telephone follow-up assessments at 3, 6, 9, and 12-months after randomization. This will allow us to determine the efficacy of MI-SI- R+EUC in reducing risk for suicide attempts (Aim 1) and reducing overall suicidal ideation (Aim 2) when compared to EUC alone. We will also explore the possibility that MI-SI-R+EUC has a differential impact among patients with different suicide attempt histories and different psychiatric disorders and investigate putative motivational mechanisms (Exploratory Aim 3). This study is significant because suicide prevention is a VHA priority and targets a population that is known to be at very high-risk with a brief intervention that has high potential for implementation. It is innovative because it tests a revised intervention that targets the motivation to live making it novel among interventions that have been tested in full-scale trials, explores potential conditions that may impact its efficacy, and examines hypothesized motivational mechanisms.

退伍军人健康管理局 (VHA) 早就知道，最近经历过自杀危机的退伍军人，例如 因为那些急性精神病住院患者的自杀风险增加。作为回应，VHA 开发了 通过增加护理协调，制定自杀预防策略并加强高危退伍军人的常规护理（EUC）， 安全计划以及 24 小时危机热线。还出现了一系列广泛的创新自杀行为 VHA 的预防试验。然而，唯一有望降低自杀风险的干预措施 退伍军人的尝试是安全规划，该规划已在整个 VHA 实施。尽管做出了这些努力， 此类危机后的自杀率已趋于稳定，并且自杀风险并未明显降低 人口，需要开发和测试额外的策略来补充已经存在的策略 实施的方法。 研究表明，减少自杀行为的治疗可能需要关注生存动机 以及为了获得最佳效果而死亡的动机。 PI 开发了励志的修订版 访谈以解决自杀意念 (MI-SI-R)，帮助退伍军人解决生活中的矛盾心理 增加生活的动力，通过电话助推器进行一对二的面对面会议 会议。在一项针对精神病院住院退伍军人的初步随机对照试验 (RCT) 中，MI-SI-R plus 与相比，EUC 可使自杀企图减少 50%，自杀意念的可能性降低 41% 单独 EUC。此外，事后分析表明 MI-SI-R 对自杀企图有更大的影响 对于那些有自杀企图史的人来说，自杀意念的影响更大，但对于那些没有自杀史的人来说，自杀意念的影响更大。 自杀未遂历史，需要复制。还需要进行更多研究来深化我们的研究 通过检查 MI-SI-R 在患者中的疗效来了解 MI-SI-R 及其假设的机制模型 不同的精神疾病及其假定的动机机制。 我们提出一项随机对照试验，在 470 个高样本样本中比较 MI-SI-R 加 EUC (MI-SI-R+EUC) 与单独 EUC。 三个 VHA 医疗中心最近出现自杀危机的退伍军人风险，“高风险”定义为自杀 一个月内尝试或自杀意念在贝克自杀意念量表上> 5。一半 (n = 235) 将是 随机分配至 MI-SI-R+EUC（三场面对面会议，通过视频连接或电话），剩余的 参与者 (n = 235) 将单独收到 EUC。所有参与者将被要求完成电话跟进 随机化后第 3、6、9 和 12 个月的评估。这将使我们能够确定 MI-SI 的功效- R+EUC 降低自杀未遂风险（目标 1）并减少总体自杀意念（目标 2） 与单独的 EUC 相比。我们还将探讨 MI-SI-R+EUC 对不同因素产生不同影响的可能性 具有不同自杀企图历史和不同精神疾病的患者并调查假定的 激励机制（探索性目标 3）。 这项研究意义重大，因为预防自杀是 VHA 的首要任务，并且针对的是已知有自杀倾向的人群。 实施具有很大潜力的简短干预措施可能会面临很高的风险。它之所以具有创新性是因为 它测试了一项修订后的干预措施，该干预措施以生活动机为目标，使其在现有的干预措施中显得新颖。 经过全面试验的测试，探索可能影响其功效的潜在条件，并检查 假设的激励机制。