Development of a Recovery Oriented Treatment for Post Acute Suicidal Episode (PASE) Veterans

为急性自杀事件后 (PASE) 退伍军人开发以恢复为导向的治疗方法

• 批准号: 10621743
• 负责人: Yosef Sokol
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10621743
• 关键词: Acute; Address; Aftercare; Age; Area; Caring; Chronic; Clinical; Cognitive Therapy; Data; Dedications; Depressed mood; Development; Exhibits; Feedback; Feeling hopeless; Feeling suicidal; Funding; Future; Goals; Group Therapy; Health; Health education; Hotlines; Hour; Individual; Intervention; Intervention Trial; Length; Life; Literature; Manuals; Maps; Mechanics; Mental Depression; Mental Health; Mental Health Services; Mentors; Monitor; Needs Assessment; Outcome; Outcome Measure; Participant; Persons; Phase; Pilot Projects; Population; Process; Protocols documentation; Psychotherapy; Quality of life; Recording of previous events; Recovery; Recovery of Function; Rehabilitation therapy; Reporting; Research; Research Personnel; Risk; Risk Factors; Role; Running; Safety; Sampling; Self Direction; Self Efficacy; Social Network; Specific qualifier value; Suicide; Suicide attempt; Suicide prevention; Symptoms; Testing; Time; Training; Update; Veterans; acceptability and feasibility; active control; arm; career; design; disability; empowerment; evidence base; experience; follow-up; high risk; implementation science; improved; male; military veteran; pilot test; primary outcome; psychoeducation; psychoeducational; readmission rates; recruit; reducing suicide; resilience; response; retention rate; satisfaction; secondary outcome; social attachment; social relationships; suicidal; suicidal individual; suicidal risk; suicide rate; therapy design; therapy development; treatment adherence; treatment arm; treatment duration

Mental health care for Veterans with suicidal symptoms is of paramount import to the VA. Unfortunately, VA suicide reports show suicide rates increasing, suggesting a need for enhancing current VA suicide mental health care efforts. While several psychotherapeutic treatments exist for acute suicidality, there is a deficit in validated treatments designed to help Veterans following an acute suicidal episode (Post Acute Suicidal Episode; PASE) such as following a non-fatal suicide attempt after acute risk declines but when they still have ongoing mental health needs and, at times, chronic suicidal symptoms. Available suicide treatments are not designed to promote the recovery and rehabilitation of PASE Veterans. This is a significant gap in comprehensive suicide-focused mental health care. One avenue to close this gap lies through the development of a recovery-oriented psychotherapy for PASE Veterans. Developing recovery-oriented care, “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential” is a VA priority; however, available treatments for suicidal Veterans have limited recovery-orientation. Decades of research into the development of suicide and processes of recovery highlight the importance of increasing Veterans hopefulness about the future, developing a positive self- identity, promoting Veterans’ sense of self-empowerment and improved relationships. Continuous Identity- Cognitive Therapy (CI-CT) is a promising new manualized suicide intervention focused on improving Veterans sense of their life story and personal future, with goals similar to recovery-oriented care. CI-CT was developed by the applicant and, as a group therapy, piloted for suicide reduction in Veterans with SMI and was found to have high levels of feasibility, acceptability and (in exploratory analyses) to lead to increased hopefulness about the future and decreased suicidal symptoms. However, CI-CT needs further adaptation for use with PASE Veterans and to enhance its alignment with the fundamentals of recovery-oriented care. The proposed study has three primary stages: First: develop an improved recovery-oriented version of the initial CI-CT Clinician Manual and Veteran workbook to further address components identified as critical for PASE recovery using, (1) an ongoing stakeholder study into the needs of PASE Veterans, (2) recovery literature, (3) scientific and Veteran consumer advisory boards and (4) iterative feedback from an online Veteran PASE sample (N=25) on each section of the workbook. This process will be guided by scientific and PASE Veteran Consumer advisory boards Second: use the materials developed in phase 1 to run 3 one-arm treatment development trials (each with an N of 4-6 PASE Veterans) to test and enhance the CI-CT treatment materials using Veteran feedback and acceptability and feasibility data. Then, with the guidance of our scientific and Veteran consumer advisory boards, use these results to update the treatment. Third: conduct a pilot RCT (N=30) comparing CI-CT for PASE Veterans to an AC (health education) to assess feasibility and acceptability of the treatment materials and research protocol including outcome measures selected and assessment strategy. We will assess rates of recruitment, intervention engagement, and session attendance (feasibility), Veteran satisfaction (acceptability), treatment adherence (fidelity) and preliminarily explore response to CI-CT. Findings will be used to make a final adaptation of the treatment materials and to develop a research protocol for a large scale RCT of CI-CT for PASE Veterans. This study will develop and pilot test a well-specified, group-based intervention tailored to the unique needs of PASE Veterans. The results of the proposed study will provide data to 1) identify adaptations needed to optimize CI-CT for PASE Veterans: 2) identify possible benefits of CI-CT; 3) inform development of a large scale RCT of CI-CT for PASE Veterans.

对有自杀症状的退伍军人的心理健康护理对于退伍军人管理局来说至关重要。不幸的是，弗吉尼亚州 自杀报告显示自杀率上升，表明需要加强当前退伍军人管理局的自杀心理 医疗保健工作。虽然有几种针对急性自杀的心理治疗方法，但在治疗方面存在缺陷 经过验证的治疗方法旨在帮助退伍军人经历急性自杀事件（急性自杀事件后） 插曲; PASE），例如在急性风险下降后尝试非致命性自杀但仍然有 持续的心理健康需求，有时还有慢性自杀症状。可用的自杀治疗方法并不 旨在促进 PASE 退伍军人的康复和康复。这是一个显着的差距 以自杀为重点的全面心理保健。缩小这一差距的一个途径是 为 PASE 退伍军人开发以恢复为导向的心理治疗。发展以康复为导向的护理，“ 个人改善健康状况、过上自我导向的生活以及 努力充分发挥他们的潜力”是退伍军人事务部的首要任务；然而，针对有自杀倾向的退伍军人的现有治疗方法已经 有限的恢复导向。对自杀的发展和康复过程进行了数十年的研究 强调增强退伍军人对未来的希望、培养积极的自我意识的重要性 身份，促进退伍军人的自我赋权和改善人际关系的意识。连续的身份- 认知疗法（CI-CT）是一种有前途的新型手动自杀干预措施，重点是改善退伍军人的状况 对他们的生活故事和个人未来的感觉，目标类似于以康复为导向的护理。开发CI-CT 由申请人进行，作为一种团体治疗，在患有 SMI 的退伍军人中试点减少自杀，结果发现 具有高水平的可行性、可接受性并且（在探索性分析中）能够增加希望 关于未来并减少自杀症状。然而，CI-CT 需要进一步调整才能与 PASE 退伍军人，并加强其与以康复为导向的护理基本原则的一致性。 拟议的研究分为三个主要阶段： 第一：开发初始 CI-CT 临床医生手册和退伍军人手册的改进版，以恢复为导向 工作簿进一步解决被确定为 PASE 恢复关键的组件，使用：(1) 持续的 利益相关者对 PASE 退伍军人需求的研究，(2) 康复文献，(3) 科学和退伍军人消费者 咨询委员会和 (4) 来自在线资深 PASE 样本 (N=25) 对每个部分的迭代反馈 作业簿。这一过程将由科学和 PASE 资深消费者咨询委员会指导 第二：使用第一阶段开发的材料进行 3 个单臂治疗开发试验（每个试验都有一个 4-6 名 PASE 退伍军人）使用退伍军人的反馈来测试和增强 CI-CT 治疗材料 可接受性和可行性数据。然后，在我们科学和经验丰富的消费者咨询的指导下 板，使用这些结果来更新治疗。 第三：进行试点 RCT (N=30)，将 PASE 退伍军人的 CI-CT 与 AC（健康教育）进行比较以进行评估 治疗材料和研究方案（包括结果测量）的可行性和可接受性 选择和评估策略。我们将评估招募率、干预参与度和疗程 出勤率（可行性）、退伍军人满意度（可接受性）、治疗依从性（保真度）和初步 探索对 CI-CT 的反应。研究结果将用于对治疗材料进行最终调整并 为 PASE 退伍军人制定 CI-CT 大规模 RCT 研究方案。 这项研究将开发并试点测试一种明确的、基于群体的干预措施，以满足不同群体的独特需求。 PASE退伍军人。拟议研究的结果将提供数据以：1）确定所需的适应措施 为 PASE 退伍军人优化 CI-CT：2) 确定 CI-CT 可能带来的好处； 3）为大型项目的开发提供信息 针对 PASE 退伍军人的 CI-CT 规模 RCT。

项目成果

Theoretical model of recovery following a suicidal episode (COURAGE): scoping review and narrative synthesis.

• DOI: 10.1192/bjo.2022.599
• 发表时间: 2022-11-17
• 期刊: BJPSYCH OPEN
• 影响因子: 5.4
• 作者: Sokol, Yosef;Levin, Chynna;Linzer, Mairav;Rosensweig, Chayim;Hubner, Shifra;Gromatsky, Molly;Walsh, Samantha;Dixon, Lisa;Goodman, Marianne
• 通讯作者: Goodman, Marianne