Reducing Suicide Risk in Older Veterans with Mental Health Disorders using Problem Solving Therapy

使用问题解决疗法降低患有精神健康障碍的老年退伍军人的自杀风险

基本信息

项目摘要

The proposed randomized control trial will examine the efficacy of a brief behavioral treatment for reducing suicidal ideation and for increasing reasons for living in older Veterans at risk for suicide. Two common issues in older adults, functional disability and executive dysfunction, increase suicide risk and will be examined as moderators and mediators of treatment outcomes. The proposed study will examine Problem Solving Therapy (PST) using a protocol that teaches skills to address emotional and practical barriers to effective problem solving. The VA usual care practice of collaborative safety planning will be the control condition, herein referred to as enhanced usual care (EUC). For participant safety, Veterans enrolled in PST will also receive EUC. The study design is random assignment to the treatment, PST plus EUC, or the control condition, EUC only. Both the treatment and the control are evidence-based interventions delivered in six sessions. The study will occur at VA Palo Alto (primary site) and VA Syracuse/VA Canandaigua (secondary site). Longitudinal assessment of suicidal ideation and reasons for living will occur at eleven timepoints: baseline, after each of the six weekly treatment sessions, posttreatment (7 weeks), at 1-, 3-, and 6- month follow-up. The recruitment goal is 150 Veterans over a five-year period with 75 participants randomized to each treatment. Veterans must be 60 years or older, report suicide ideation, and meet diagnostic criteria for a depressive disorder, anxiety disorder, and/or posttraumatic stress disorder to be eligible. Veterans will be excluded and referred for other services if they have psychotic symptoms, bipolar disorder, severe OCD, or elevated symptoms indicative of borderline personality disorder; an alcohol/substance use disorder; severe or unstable medical conditions; recent head injury (past year) or history of a head injury with loss of consciousness for 24 or more hours; terminal illness; positive cognitive screen indicative of possible dementia; or if they are unable to participate in the study or follow-up sessions. Recruitment will occur through multiple strategies at VA, Vet centers, and in the community to ensure the feasibility of recruiting a total of 75 Veterans at each site. To meet this recruitment goal, the primary and secondary site will each enroll 2 to 3 Veterans per month. Fidelity ratings of audiotaped treatment sessions will be made by independent raters on 20% of sessions. Mixed effects modeling will be used to estimate the effect of treatment versus the control for the outcomes of suicidal ideation and reasons for living. Models will covary for demographics, medical and psychiatric comorbidity, and psychotropic use. For the primary aim, models will determine whether PST plus EUC is associated with a larger treatment effect compared with EUC only for suicidal ideation and reasons for living. Secondary aims will determine if baseline functional disability and executive dysfunction moderate treatment outcomes, and whether a change in these two variables from baseline to posttreatment are significantly associated with (mediate) change in suicidal ideation and reasons for living. The tertiary aims will use qualitative methods to assess Veteran satisfaction with the treatment and control including the types of problems with which treatment helped them, and suggestions for improving it for future Veterans. The current VA/DoD Clinical Practice Guidelines (CPGs) for suicide do not list treatment options specifically for older Veterans despite the majority of VHA patients being 55 years or older. Thus, evidence-based outcomes from the proposed work have potential to inform the CPG recommendations for using PST with Safety Planning and/or Safety Planning alone with older Veterans. Dissemination of the treatment could be supported by expanding existing VA training infrastructure in problem solving based interventions.
拟议的随机对照试验将检查一个简短的行为治疗,以减少 自杀念头以及生活在老年退伍军人中有自杀风险的原因越来越多。两个共同问题 在老年人中,功能性残疾和执行功能障碍会增加自杀风险,并将作为 治疗结果的调节者和介导者。这项研究将探讨问题解决疗法 (PST)使用教授技能的协议,以解决有效问题的情感和实际障碍 解决协作安全计划的VA常规护理实践将是控制条件,此处引用 增强常规护理(EUC)。为了参与者的安全,参加PST的退伍军人也将获得EUC。的 研究设计是随机分配到治疗组(PST + EUC)或对照组(仅EUC)。两 治疗和控制是以证据为基础的干预措施,分六次进行。研究将在 在VA Palo Alto(主要研究中心)和VA锡拉丘兹/VA Canandaigua(次要研究中心)。 将在11个时间点对自杀意念和生存原因进行纵向评估: 基线、每6周一次治疗后、治疗后(7周)、第1、3和6周 月随访。招募目标是在五年内招募150名退伍军人,其中75人参加 随机分配至各治疗组。退伍军人必须年满60岁,报告自杀意念,并满足 抑郁症、焦虑症和/或创伤后应激障碍的诊断标准, 合资格的.退伍军人将被排除在外,并转介其他服务,如果他们有精神病症状, 双相情感障碍、严重强迫症或提示边缘型人格障碍的症状升高; 酒精/物质使用障碍;严重或不稳定的医疗状况;近期头部受伤(过去一年) 或有头部损伤伴意识丧失24小时或更长时间的病史;晚期疾病;阳性 提示可能患有痴呆症的认知筛查;或如果他们无法参与研究,或 后续会议。招募将通过VA、Vet中心和 社区,以确保在每个地点招募75名退伍军人的可行性。为了满足这次招聘 为了达到这一目标,主要和次要研究中心每月将分别招募2至3名退伍军人。 将由独立评分员对20%的治疗会话进行录音记录的保真度评分。 将使用混合效应模型来估计治疗与对照对以下结局的影响: 自杀意念和生存的理由。模型将根据人口统计学、医学和精神病学进行协变 合并症和精神药物使用。对于主要目标,模型将确定PST加EUC是否 与仅针对自杀意念和生存原因的EUC相比,与更大的治疗效果相关。 次要目的将确定基线功能障碍和执行功能障碍是否为中度治疗 结果,以及这两个变量从基线到治疗后的变化是否显著 与自杀意念和生活原因的(中介)变化相关。第三个目标将使用 评估退伍军人对治疗和控制满意度的定性方法,包括 治疗对他们有帮助的问题,以及为未来退伍军人改进治疗的建议。当前 VA/DoD自杀临床实践指南(CPG)没有列出专门针对老年人的治疗方案。 退伍军人,尽管大多数VHA患者年龄在55岁或以上。因此,基于证据的结果, 拟议的工作有可能为中央处理小组关于在安全规划中使用性能测试的建议提供信息 和/或安全规划单独与老年退伍军人。可以通过以下方式支持治疗的传播: 在解决问题的干预措施中扩大现有的退伍军人事务培训基础设施。

项目成果

期刊论文数量(1)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
Beyond maintaining safety: Examining the benefit of emotion-centered problem solving therapy added to safety planning for reducing late life suicide risk.
除了维持安全之外:检查以情绪为中心的问题解决疗法添加到安全计划中以降低晚年自杀风险的好处。
  • DOI:
    10.1016/j.cct.2023.107147
  • 发表时间:
    2023
  • 期刊:
  • 影响因子:
    2.2
  • 作者:
    Beaudreau,SherryA;Lutz,Julie;Wetherell,JulieLoebach;Nezu,ArthurM;Nezu,ChristineMaguth;O'Hara,Ruth;Gould,ChristineE;Roelk,Brandi;Jo,Booil;Hernandez,Beatriz;Samarina,Viktoriya;Otero,MarcelaC;Gallagher,Alana;Hirsch,James;Fun
  • 通讯作者:
    Fun
{{ item.title }}
{{ item.translation_title }}
  • DOI:
    {{ item.doi }}
  • 发表时间:
    {{ item.publish_year }}
  • 期刊:
  • 影响因子:
    {{ item.factor }}
  • 作者:
    {{ item.authors }}
  • 通讯作者:
    {{ item.author }}

数据更新时间:{{ journalArticles.updateTime }}

{{ item.title }}
  • 作者:
    {{ item.author }}

数据更新时间:{{ monograph.updateTime }}

{{ item.title }}
  • 作者:
    {{ item.author }}

数据更新时间:{{ sciAawards.updateTime }}

{{ item.title }}
  • 作者:
    {{ item.author }}

数据更新时间:{{ conferencePapers.updateTime }}

{{ item.title }}
  • 作者:
    {{ item.author }}

数据更新时间:{{ patent.updateTime }}

Sherry Ann Beaudreau其他文献

Sherry Ann Beaudreau的其他文献

{{ item.title }}
{{ item.translation_title }}
  • DOI:
    {{ item.doi }}
  • 发表时间:
    {{ item.publish_year }}
  • 期刊:
  • 影响因子:
    {{ item.factor }}
  • 作者:
    {{ item.authors }}
  • 通讯作者:
    {{ item.author }}

{{ truncateString('Sherry Ann Beaudreau', 18)}}的其他基金

Reducing Suicide Risk in Older Veterans with Mental Health Disorders using Problem Solving Therapy
使用问题解决疗法降低患有精神健康障碍的老年退伍军人的自杀风险
  • 批准号:
    10398811
  • 财政年份:
    2021
  • 资助金额:
    --
  • 项目类别:

相似海外基金

Co-designing a lifestyle, stop-vaping intervention for ex-smoking, adult vapers (CLOVER study)
为戒烟的成年电子烟使用者共同设计生活方式、戒烟干预措施(CLOVER 研究)
  • 批准号:
    MR/Z503605/1
  • 财政年份:
    2024
  • 资助金额:
    --
  • 项目类别:
    Research Grant
Early Life Antecedents Predicting Adult Daily Affective Reactivity to Stress
早期生活经历预测成人对压力的日常情感反应
  • 批准号:
    2336167
  • 财政年份:
    2024
  • 资助金额:
    --
  • 项目类别:
    Standard Grant
RAPID: Affective Mechanisms of Adjustment in Diverse Emerging Adult Student Communities Before, During, and Beyond the COVID-19 Pandemic
RAPID:COVID-19 大流行之前、期间和之后不同新兴成人学生社区的情感调整机制
  • 批准号:
    2402691
  • 财政年份:
    2024
  • 资助金额:
    --
  • 项目类别:
    Standard Grant
Migrant Youth and the Sociolegal Construction of Child and Adult Categories
流动青年与儿童和成人类别的社会法律建构
  • 批准号:
    2341428
  • 财政年份:
    2024
  • 资助金额:
    --
  • 项目类别:
    Standard Grant
Elucidation of Adult Newt Cells Regulating the ZRS enhancer during Limb Regeneration
阐明成体蝾螈细胞在肢体再生过程中调节 ZRS 增强子
  • 批准号:
    24K12150
  • 财政年份:
    2024
  • 资助金额:
    --
  • 项目类别:
    Grant-in-Aid for Scientific Research (C)
Understanding how platelets mediate new neuron formation in the adult brain
了解血小板如何介导成人大脑中新神经元的形成
  • 批准号:
    DE240100561
  • 财政年份:
    2024
  • 资助金额:
    --
  • 项目类别:
    Discovery Early Career Researcher Award
RUI: Evaluation of Neurotrophic-Like properties of Spaetzle-Toll Signaling in the Developing and Adult Cricket CNS
RUI:评估发育中和成年蟋蟀中枢神经系统中 Spaetzle-Toll 信号传导的神经营养样特性
  • 批准号:
    2230829
  • 财政年份:
    2023
  • 资助金额:
    --
  • 项目类别:
    Standard Grant
Usefulness of a question prompt sheet for onco-fertility in adolescent and young adult patients under 25 years old.
问题提示表对于 25 岁以下青少年和年轻成年患者的肿瘤生育力的有用性。
  • 批准号:
    23K09542
  • 财政年份:
    2023
  • 资助金额:
    --
  • 项目类别:
    Grant-in-Aid for Scientific Research (C)
Identification of new specific molecules associated with right ventricular dysfunction in adult patients with congenital heart disease
鉴定与成年先天性心脏病患者右心室功能障碍相关的新特异性分子
  • 批准号:
    23K07552
  • 财政年份:
    2023
  • 资助金额:
    --
  • 项目类别:
    Grant-in-Aid for Scientific Research (C)
Issue identifications and model developments in transitional care for patients with adult congenital heart disease.
成人先天性心脏病患者过渡护理的问题识别和模型开发。
  • 批准号:
    23K07559
  • 财政年份:
    2023
  • 资助金额:
    --
  • 项目类别:
    Grant-in-Aid for Scientific Research (C)
{{ showInfoDetail.title }}

作者:{{ showInfoDetail.author }}

知道了