Effects of Neuromodulation and Cognitive Training for Suicide in Veterans (ENACTS)

神经调节和认知训练对退伍军人自杀的影响 (ENACTS)

• 批准号: 10623228
• 负责人: CASEY S GILMORE
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10623228
• 关键词: Acceleration; Address; Admission activity; Behavior Therapy; Benchmarking; Brain; Cessation of life; Clinical; Cognitive; Confidence Intervals; Controlled Clinical Trials; Data; Decision Making; Ecological momentary assessment; Educational Intervention; Effectiveness; Effectiveness of Interventions; Epidemic; Event; Executive Dysfunction; Exercise; Feedback; Feeling suicidal; Follow-Up Studies; Future; Goals; Health Resources; Healthcare Systems; Hospitalization; Hospitals; Impairment; Impulsivity; Inpatients; Intervention; Interview; Learning; Measures; Methods; Participant; Patients; Performance; Persons; Population; Prevention program; Quality of life; Questionnaires; Randomized; Recording of previous events; Research; Risk; Risk Reduction; Safety; Services; Suicide; Suicide attempt; Suicide prevention; Surveys; Task Performances; Technology; Time; Training; United States; Veterans; Visit; acceptability and feasibility; cognitive training; cost; effectiveness testing; executive function; experience; feasibility testing; follow-up; help-seeking behavior; high risk; ideation; improved; intervention effect; military veteran; neuroregulation; pilot trial; recruit; reducing suicide; retention rate; satisfaction; social relationships; suicidal; suicidal behavior; suicidal risk; transcranial direct current stimulation

Impaired executive function, such as impaired decision making and impulsivity, has been identified as an important contributor to the transition from suicidal ideation to suicide attempt. To address the epidemic of Veteran suicide in the United States, we propose to test the feasibility, acceptability, and preliminary effectiveness of a five day transcranial direct current stimulation (tDCS) augmented executive functioning training intervention. This intervention will be delivered to high suicide risk inpatients who have been hospitalized following a suicide attempt. The ultimate goal is to reduce future suicide events (ideation, attempts, deaths) and improve quality of life (e.g. social relationships, health resource utilization). Our intervention combines two existing interventions: tDCS and cognitive training. tDCS is a simple, low cost, easy to use non-invasive neuromodulation technology demonstrated to enhance brain plasticity and accelerate learning. Executive function training is a proven intervention that improves executive functioning in clinical populations. When tDCS and executive function training are combined, learning rate, executive functioning, and transfer to other functions is improved compared with executive function training alone. We propose to test the feasibility and acceptability of a five day intervention consisting of ten sessions of tDCS augmented executive function training in a high suicide risk population: Veterans admitted to a hospital following a suicide attempt. Inpatients have the highest risk of suicide attempts within the initial weeks following discharge with 50% occuring within 12 weeks of discharge. This suggests that the time prior to hospital discharge could be a critical intervention period. Additionally, we will collect longitudinal and daily real-time data on help-seeking, suicide risk, and related factors in the month after discharge using Ecological Momentary Assessment (EMA). Given that help-seeking and suicide risk fluctuate during the week, EMA offers an improvement over existing research that relies on retrospective and cross-sectional methods. Our Aims are: Aim 1: Determine feasibility and acceptability of the tDCS augmented executive function training intervention. Feedback will be obtained from patients and clinical staff through questionnaires, interviews, and debriefs to examine their experience and satisfaction with the intervention and study methods. We will also use participants’ performance data to assess engagement with, and ease of use of, the training exercises. Aim 2: Assess preliminary effects of the intervention on 1) the behavioral treatment target of executive functioning, and 2) reduction in suicide events (ideation, attempts, deaths) and improvement in quality of life. Variability and precision estimates (95% confidence intervals) will be calculated. Aim 3: Explore between- and within-person variability of cognitive factors (executive function task performance), help-seeking, and suicidal thinking and behavior in the one month post-discharge via in-person visits and daily Ecological Momentary Assessment (EMA). Significance. Reducing Veteran suicide has been the top clinical priority of the VA for the last few years. However, the total number of suicides among Veterans has continued to increase. There is a critical need for targeted treatments to reduce the risk of suicide in Veterans. The low cost, simplicity, and safety of this intervention makes it easy to deliver and scale to clinical settings. If this pilot trial is successful, it would set the stage for a larger trial to test the effectiveness of this intervention for reducing suicide events in a high suicide risk population.

执行功能受损，例如决策受损和冲动，已被确定为 从自杀意念到自杀未遂转变的重要因素。为应对疫情 美国退伍军人自杀，我们建议测试一下可行性、可接受性，初步 五天经颅直流电刺激 (tDCS) 增强执行功能的有效性 培训干预。该干预措施将针对曾接受过自杀治疗的高自杀风险住院患者。 自杀未遂后住院。最终目标是减少未来的自杀事件（意念、 尝试、死亡）并改善生活质量（例如社会关系、卫生资源利用）。 我们的干预措施结合了两种现有的干预措施：经颅直流电刺激 (tDCS) 和认知训练。 tDCS 是一种简单、低成本、 易于使用的非侵入性神经调节技术被证明可以增强大脑可塑性并加速 学习。执行功能训练是一种经过验证的干预措施，可以改善临床中的执行功能 人口。当 tDCS 和执行功能训练相结合时，学习率、执行功能、 与单独的执行功能训练相比，向其他功能的转移得到了改善。 我们建议测试由 10 次 tDCS 组成的五天干预的可行性和可接受性 高自杀风险人群的增强执行功能训练：入院的退伍军人 自杀未遂后。住院患者在住院后的最初几周内企图自杀的风险最高 出院 50% 发生在出院后 12 周内。这表明入院前的时间 出院可能是一个关键的干预时期。此外，我们将收集纵向和每日实时数据 使用生态瞬时法了解出院后一个月内的寻求帮助、自杀风险和相关因素 评估（EMA）。鉴于寻求帮助和自杀风险在一周内波动，EMA 提供了 改进依赖回顾性和横断面方法的现有研究。我们的目标是： 目标 1：确定 tDCS 增强执行功能训练干预的可行性和可接受性。 将通过问卷、访谈和汇报从患者和临床工作人员那里获得反馈 检查他们对干预和研究方法的体验和满意度。我们还将使用 参与者的表现数据，用于评估培训练习的参与度和易用性。 目标 2：评估干预措施对 1）高管行为治疗目标的初步效果 功能，2) 减少自杀事件（意念、自杀未遂、死亡）并提高生活质量。 将计算变异性和精度估计（95% 置信区间）。 目标 3：探索认知因素（执行功能任务 出院后一个月内通过面对面的方式寻求帮助以及自杀想法和行为 访问和每日生态瞬时评估（EMA）。 意义。过去几年来，减少退伍军人自杀一直是退伍军人管理局临床工作的首要任务。 然而，退伍军人的自杀总数仍在持续增加。迫切需要 有针对性的治疗，以降低退伍军人的自杀风险。其成本低、简单且安全 干预使得在临床环境中的交付和扩展变得容易。如果该试点试验成功，将设定 进行更大规模试验的阶段，以测试这种干预措施在减少高自杀率中自杀事件的有效性 危险人群。