Development of a Novel Couples-Based Suicide Intervention: Treatment for Relationships and Safety Together (TR&ST)

背景：自杀是美国和世界范围内死亡的主要原因之一， 美国退伍军人的死亡率（每10万人中有27.7人）是平民水平（每10万人中有14.7人）的两倍。 尽管加强了预防工作，但发病率继续上升。自杀与康复理论 心理学强调人与环境的相互作用对残疾的重要性 体验.具体来说，研究一直发现，自杀最常见的诱因是 和一个浪漫的伴侣。相反，人际关系运作良好的人不太可能 自杀的念头《国际功能、残疾和健康分类》（ICF）确定了 参与和沟通是运作的重要组成部分。预防高危人群自杀 退伍军人是至关重要的，一个人的亲密关系的质量是一个研究不足的干预 预防自杀的目标。本建议提炼和评估初步疗效的第一对夫妇为基础的 自杀干预-关系和安全共同治疗（TR&ST）。 意义/创新：自杀预防是VA/DoD的首要临床优先事项。必须包括 退伍军人自杀相关护理中的家庭成员是国家预防战略的重要组成部分。 退伍军人自杀2018-2028和2019年进行的VA/DoD患者焦点小组的关键发现 VA/DoD临床实践指南评估和管理有自杀风险的患者。 该CDA-2提案的创新方面直接涉及国家报告的几个组成部分，包括： 1)第一对夫妇为基础的自杀特异性干预和第一次自杀特异性干预的目标 由自杀理论和康复心理学确定的人际功能因素（即，有效 沟通和人际交往）; 2）以退伍军人为中心的家庭远程教育之间的选择 保健和基于办公室的护理，以增加获得服务的机会; 3）提高退伍军人数据分析的质量 通过检查退伍军人和伴侣报告的自杀相关风险因素（第一次自杀- 具体的治疗研究来做到这一点）。 方法：拟议的5年研究包括两个阶段。第1阶段：治疗优化，10 夫妇（N=20）和2期：TR&ST与VA标准相比的先导性随机对照试验（RCT） 60对夫妇的自杀干预（N=120）。干预期为13周，整个研究期 大约7个月。两个阶段的夫妇将在基线、治疗中期 治疗后和治疗后3个月（并在每个TR&ST模块后进行定性访谈）。 要评价的主要结局是自杀意念严重程度的变化。次要结局问题 人际功能的变化。 目的：目的1（第1阶段）：在具有主动自杀意念的退伍军人人群中完善TR和ST。目标2（阶段 2）：评估TR& ST的治疗可行性和可接受性。目标3（第2阶段）：比较TR&ST与VA 自杀意念严重程度和人际功能的标准自杀干预（即，通信， 亲密度、关系满意度、责任感和负担感）。 下一步：这个职业发展奖是朝着发展一个重要的研究计划的第一步 在VHA内，通过让家人参与， 成员在治疗。如果目标实现，未来的工作包括1）一个足够强大的随机对照试验的TR&ST vs. VA标准自杀干预2）更直接地评估基于夫妇或家庭的远程保健 参与自杀的具体干预措施，以及3）审查主持人或利益集团（如 退伍军人）。

Background: Suicide is one of the leading causes of death in the United States and worldwide, with suicide rates among U.S. military veterans doubling (27.7 per 100,000) the rate of civilian levels (14.7 per 100,000). Despite a rise in prevention efforts, rates have continued to increase. Theories of suicide and rehabilitation psychology stress the importance of the person-environment interaction in contributing to one’s disability experience. Specifically, research has consistently found that the most frequent precipitant of suicide is a problem with a romantic partner. Conversely, people with better relationship functioning are less likely to have suicidal thoughts. The International Classification of Functioning, Disability and Health (ICF) identifies social engagement and communication as important components of functioning. Prevention of suicide in at-risk veterans is of vital importance and the quality of one’s intimate relationship is an understudied intervention target for suicide prevention. This proposal refines and evaluates preliminary efficacy of the first couples-based suicide-specific intervention—Treatment for Relationships and Safety Together (TR&ST). Significance/Innovation: Suicide prevention is the top clinical priority for VA/DoD. The importance of including family members in Veterans’ suicide-related care is a critical component of the National Strategy for Preventing Veteran Suicides 2018-2028 and key finding from VA/DoD patient focus groups conducted for the 2019 VA/DoD Clinical Practice Guidelines for the Assessment and Management of Patients at Risk for Suicide. Innovative aspects of this CDA-2 proposal directly address several components of national reports and include: 1) The first couples-based suicide-specific intervention and the first suicide-specific intervention to target interpersonal functioning factors identified by suicide theories and rehabilitation psychology (i.e., effective communication and interpersonal engagement); 2) Veteran-centric choice between home-based telemental health and office-based care in order to increase access; and 3) Improved data analytic quality of Veteran suicidality by examining both Veteran and partner reports of suicide related risk factors (the first suicide- specific treatment study to do this). Methodology: The proposed 5-year study consists of two phases. Phase 1: treatment refinement with 10 couples (N=20) and Phase 2: pilot Randomized Controlled Trial (RCT) of TR&ST compared to VA Standard Suicide Intervention with 60 couples (N=120). The intervention period is 13 weeks and the entire study period is approximately 7 months. Couples in both phases will be quantitatively assessed at baseline, mid-treatment, post-treatment, and 3-months post-treatment (and qualitatively interviewed following each TR&ST module). The primary outcome to be evaluated is change in suicidal ideation severity. Secondary outcomes concern changes in interpersonal functioning. Aims: Aim 1 (Phase 1): Refine TR&ST in a population of Veterans with active suicidal ideation. Aim 2 (Phase 2): Evaluate treatment feasibility and acceptability of TR&ST. Aim 3 (Phase 2): Compare TR&ST vs. VA Standard Suicide Intervention on suicidal ideation severity and interpersonal functioning (i.e., communication, bonding, relationship satisfaction, and belonginess and burdensomeness) over 7 months. Next Steps: This Career Development Award is the first step toward developing a vital program of research within VHA focused on enhancing interpersonal functioning and suicide-related care by involving family members in treatment. If Aims are achieved, future work includes 1) an adequately powered RCT of TR&ST vs. VA Standard Suicide Intervention 2) a more direct evaluation of telehealth for couples-based or family involvement in suicide-specific interventions, and 3) examination of moderators or groups of interest (such as women Veterans).