Development of an Intervention for Suicide Attempters

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DESCRIPTION (provided by applicant): Suicide and attempted suicide are major public health issues in the United States, with suicide accounting for more than 29,000 deaths in the year 2000 and attempted suicide accounting for over 400,000 hospital admissions. Although recent years have seen significant advances in our knowledge of efficacious treatments for many psychiatric disorders, the suicide rates in this country have not decreased substantially. Despite the high public health significance of suicide and the apparent inability of our current psychiatric treatments to influence suicide rates, there has been relatively little research devoted to developing or testing interventions that directly target suicidal behavior. This treatment development grant seeks to address this limitation by developing an integrated, adjunctive treatment program for individuals who have made a previous suicide attempt. More specifically, we propose to develop a treatment program aimed at reducing subsequent suicidal behavior in a high risk sample - adult patients with major depression admitted to a psychiatric hospital following a suicide attempt. In its preliminary format, this intervention, tentatively named the Coping Long- term with Attempted Suicide Program (CLASP), is comprised of three major components: a) three individual meetings while the patient is in the hospital, b) one in-person meeting with the patient and his/her significant other(s) and c) a series of scheduled telephone contacts with the patient and significant other for six months following discharge from the hospital. The overall aim of this application is to further develop the CLASP intervention and to collect preliminary data on the efficacy of this treatment program. More specifically, we propose to: 1. Develop a comprehensive treatment manual for the CLASP treatment - a multi-modal intervention that consists of an integration of treatment strategies from cognitive-behavioral psychotherapies and family interventions. 2. Develop, implement and evaluate a therapist training program. 3. Develop and test the reliability and validity of adherence and competence rating scales to evaluate therapists' adherence to the treatment manual and their competence in delivering the treatment. 4. Conduct a randomized controlled pilot study in a sample of inpatients with a recent suicide attempt to: a) assess the feasibility and acceptability of the proposed treatment, and b) to provide an estimate of effect size of the efficacy of CLASP in reducing suicidal behavior in comparison to Enhanced Treatment As Usual. This pilot study will lay the groundwork for a larger clinical trial evaluating the efficacy of this new treatment for suicide in this high risk group of patients.