Effects of a Targeted Web-Based Suicide Prevention Intervention on Suicidal Ideation and Self-Directed Violence: A Randomized Controlled Trial in Veterans

基于网络的有针对性的自杀预防干预对自杀意念和自我导向暴力的影响：退伍军人的随机对照试验

• 批准号: 10589275
• 负责人: Joseph William Boffa
• 金额: --
• 依托单位: SOUTHEAST LOUISIANA VETERANS HEALTH CARE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10589275
• 关键词: Accident and Emergency department; Address; Adopted; Age; Agreement; Area; Award; Behavior; Caring; Clinic; Clinical; Clinical Investigator; Clinical Trials; Confidence Intervals; Coping Skills; Data; Development; Distress; Educational process of instructing; Effectiveness; Emergency Situation; Ensure; Evaluation; Evidence based intervention; Experimental Designs; Feeling suicidal; Goals; Health; Home; Individual; Intervention; Interview; Measures; Mediating; Mental Depression; Mental Health; Mental Health Services; Online Systems; Outpatients; Patient Self-Report; Positioning Attribute; Preparation; Prevention; Prevention Research; Primary Care; Principal Investigator; Psychotherapy; Questionnaires; Randomized; Randomized, Controlled Trials; Reporting; Research; Research Personnel; Research Project Grants; Sampling; Self Direction; Severities; Structure; Suicide; Suicide prevention; Syndrome; Technology; Testing; Therapeutic; Training; Training Activity; United States; United States Department of Veterans Affairs; Veterans; Violence; arm; comparison control; comparison intervention; coping; design; effectiveness evaluation; efficacy evaluation; emotional distress; evidence base; follow-up; health care settings; improved; indexing; innovation; mHealth; mobile application; novel; prevent; preventive intervention; primary care clinic; programs; psychologic; randomized, clinical trials; recruit; reducing suicide; response; sex; skills; suicidal; suicidal behavior; suicidal risk; suicide rate; therapy design; treatment as usual; web-based intervention

Suicide has been an increasingly prominent health concern among Veterans over the past 20 years. The Department of Veterans Affairs (VA) National Strategy for Preventing Veteran Suicide calls for robust and innovative solutions to existing suicide prevention efforts, including improvements to existing psychotherapeutic interventions. Effective suicide prevention interventions should identify and target mechanisms of suicide risk in the most efficient manner possible. One strategy includes a skills-based approach to reducing psychological inflexibility (cf. distress) related to suicidal ideation, thereby preventing suicidal thoughts from progressing to more severe forms of self-directed violence. Moreover, distilling these treatment components into a format that is more easily disseminated (i.e., single session, web-based) would improve Veteran access to effective suicide prevention interventions. Unfortunately, few clinical suicide prevention interventions have adopted either of these approaches, and none to date appear to have combined them in a manner that would provide an effective adjunctive suicide-specific intervention that could be administered across both traditional and non-traditional (e.g., primary care, emergency clinics) mental health settings. To that end, the Principal Investigator (PI) previously developed and tested a web-based intervention designed to reduce psychological inflexibility related to suicidal ideation, termed Re-Evaluating Suicidal Thoughts (REST). In a randomized clinical trial (RCT) of 98 non-Veteran outpatients, REST reduced psychological inflexibility and severity of suicidal ideation compared to controls. In a one-arm acceptability trial of 24 Veteran outpatients, REST was rated as highly relevant, helpful, and easy to use. The objective of the current proposal is therefore to evaluate the effectiveness of REST as an adjunctive suicide prevention intervention among Veterans in an integrated health care setting. The specific aims are to: evaluate the effect of REST on psychological inflexibility of suicidal ideation (Aim 1); evaluate the effect of REST on suicidal ideation severity and self-directed violence (Aim 2); and identify the therapeutic mechanism of REST in reducing suicidal ideation severity (Aim 3). Primary hypotheses include: compared to controls, REST will result in lower psychological inflexibility of suicidal ideation at one-week follow-up (Hypothesis 1) and lower suicidal ideation severity and reported self-directed violence at one-month follow-up (Hypothesis 2a and b); and that reductions in psychological inflexibility will account for reductions in suicidal ideation severity and self- directed violence (Hypothesis 3a and b). To accomplish these aims, the PI will recruit Veterans with current suicidal ideation (N = 150) to be randomized to receive REST or maintain treatment-as-usual (TAU control). Self- report measures of psychological inflexibility and severity of suicidal ideation will be administered at pre- intervention, one-week, and one-month follow-up. Reports of self-directed violence (e.g., plans, preparatory behaviors, and attempts) will be collected via clinical interview at baseline, one-week, and one-month follow-up. The aims of this study will in part address key aspects of VA’s National Strategy for Preventing Veteran Suicide. Specifically, this RCT “evaluate the effectiveness of Veteran suicide prevention interventions” (Objective 13.1). Demonstrating the effectiveness of a web-based suicide prevention intervention will further “promote timely access to intervention and effective care for Veterans with a heightened risk for suicide” (Objective 8.2). The activities in this proposal will position the PI to become a leading independent investigator in VA with a focus on clinical interventions for suicide prevention. The overall training goal of this proposal is to develop an expertise in the development and empirical evaluation of scalable clinical interventions that address suicide risk. Training aims include expertise in clinical trials research, clinical interventions for suicide risk, and leveraging technology to enhance suicide prevention efforts. The research and training aims included herein will position the PI to submit a VA Merit Award, grow a research program rooted in evidence-based approaches to Veteran suicide prevention interventions, and become a leading clinical investigator in VA suicide prevention research.

在过去的20年里，自杀在退伍军人中一直是一个日益突出的健康问题。这个 退伍军人事务部(VA)防止退伍军人自杀国家战略呼吁大力和 对现有自杀预防工作的创新解决方案，包括改进现有的心理治疗 干预措施。有效的自杀预防干预措施应确定和针对自杀风险的机制 尽可能以最高效的方式。一种策略包括以技能为基础的方法来减少心理压力 不灵活(参见痛苦)与自杀念头有关，从而阻止自杀念头发展到 更严重的自我导向的暴力形式。此外，将这些处理成分蒸馏成一种格式 更容易传播(即，单次会议，基于网络)将改善退伍军人有效自杀的机会 预防干预措施。不幸的是，很少有临床自杀预防干预采用这两种方法中的任何一种。 方法，到目前为止，似乎还没有一种方法以一种能够提供有效的 可跨传统和非传统实施的针对自杀的辅助性干预 (例如，初级保健、急诊)心理健康环境。为此，首席调查员(PI) 之前开发并测试了一种基于网络的干预措施，旨在减少心理上的僵化 对于自杀念头，称为重新评估自杀念头(REST)。在1998年的一项随机临床试验(RCT)中 与非退伍军人门诊患者相比，休息减少了心理僵化和自杀念头的严重性 控制。在一项针对24名资深门诊患者的单臂可接受性试验中，REST被评为高度相关、有帮助、 而且使用起来很方便。因此，当前提案的目标是评价REST作为一种 在综合卫生保健环境中对退伍军人进行辅助自杀预防干预。具体目标 评估休息对自杀意念心理僵化的影响(目标1)；评估效果 依赖于自杀念头、严重性和自我导向的暴力(目标2)；并确定治疗机制 在减少自杀意念严重性方面的休息(目标3)。主要假设包括：与对照组相比，休息 在一周的随访期内(假设1)，自杀意念的心理僵化程度较低 自杀意念的严重程度和一个月后报告的自我定向暴力(假设2a和b)； 心理僵化的减少将导致自杀念头的严重性和自我意识的减少。 定向暴力(假设3a和b)。为了实现这些目标，PI将招募目前有能力的退伍军人 将自杀意念(N=150)随机分为接受休息或维持照常治疗(TAU对照)。自我- 自杀意念的心理僵化和严重程度的报告测量将在 干预、1周、1个月随访。关于自我导向的暴力的报告(例如，计划、筹备 行为和尝试)将通过临床访谈收集在基线、一周和一个月的随访中。 这项研究的目的将在一定程度上解决退伍军人自杀预防国家战略的关键方面。 具体地说，这项随机对照研究“评估老兵自杀预防干预措施的有效性”(目标13.1)。 展示基于网络的自杀预防干预的有效性将进一步“促进及时 向自杀风险较高的退伍军人提供干预和有效护理“(目标8.2)。这个 该提案中的活动将使PI成为退伍军人管理局的领先独立调查员，重点是 预防自杀的临床干预措施。这项建议的总体培训目标是发展专业知识 在针对自杀风险的可扩展临床干预措施的开发和实证评估中。培训 目标包括在临床试验研究、自杀风险的临床干预和利用技术方面的专业知识 加强预防自杀的工作。本文中包括的研究和培训目标将使PI定位于 提交退伍军人优秀奖，发展以循证方法为基础的研究项目，解决老兵自杀问题 预防干预，并成为退伍军人自杀预防研究的领先临床研究员。