Group (“Project Life Force”) vs. Individual Suicide Safety Planning RCT

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Despite the enrichment of VA suicide prevention services and implementation of the national suicide hotline, Veteran suicide completions occur 20 times 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. Safety Planning in Veterans presenting to an emergency room has been shown to decrease suicide behavior. 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 10-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, augmenting physical well being and strategies how to share their plan with family/significant others and their treatment team. 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. PLF received pilot SPiRE funding from the VA Rehabilitation and Research Development in 2015 to finalize the development of the intervention’s manual and pilot the intervention in Veterans. Preliminary data suggests high levels of feasibility, and acceptability. 100% of participants developed updated safety plans and increased use patterns and a significant decrease in suicidal ideation. This project’s aim is to conduct a multi-site (James J Peters VAMC and Philadelphia VA) randomized clinical trial (RCT) of PLF versus treatment as usual (TAU) that includes individual telephone review of safety plans in 265 suicidal Veterans with follow up to one year. The primary outcome variable is suicidal behavior, using a rigorous, multi-method assessments follow-up. Secondary outcomes include depression, hopelessness and treatment utilization. Exploratory analyzes will examine whether changes in suicide coping and levels of group cohesion in PLF mediate treatment response. Methodological rigor includes ongoing adherence ratings for PLF and assessment training/monitoring by an independent third site (Columbia University).