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（例如决策和冲动受损）已被确定为 从自杀思想过渡到自杀企图的重要贡献者。解决流行病的流行 我们在美国自杀，我们建议测试可行性，可接受性和初步 为期五天的经颅直流电流刺激（TDC）的有效性增强了执行功能 培训干预措施。这种干预将被交付给高自杀的风险住院患者 自杀企图后住院。最终目标是减少未来的自杀事件（构想， 尝试，死亡）和改善生活质量（例如社会关系，健康资源利用）。 我们的干预措施结合了两种现有干预措施：TDC和认知培训。 TDC是一个简单，低成本的， 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。执行功能培训是一种经过验证的干预措施，可改善临床的执行功能 人群。当TDC和执行功能培训合并时，学习率，执行功能， 与仅执行功能培训相比，转移到其他功能的转移得到了改善。 我们建议测试由TDC的十次会议组成的五天干预措施的可行性和可接受性 增强自杀风险人口的执行职能培训：退伍军人入院 自杀企图。住院患者在接下来的几周内自杀企图的风险最高 出院后出现50％，在出院后的12周内发生。这表明医院前的时间 出院可能是关键的干预期。此外，我们将收集纵向和每日实时数据 关于寻求帮助，自杀风险和相关因素在出院后使用生态瞬间的一个月 评估（EMA）。鉴于寻求帮助和自杀的风险在一周内波动，EMA提供了 改善了依赖回顾性和横截面方法的现有研究。我们的目标是： 目标1：确定TDCS的可行性和可接受性增强执行功能培训干预措施。 将通过问卷，访谈和汇报从患者和临床人员那里获得反馈 检查他们对干预和研究方法的经验和满意度。我们还将使用 参与者的绩效数据，以评估培训练习的参与和易用性。 目标2：评估干预对1）行政行为治疗目标的初步影响 功能和2）减少自杀事件（构想，尝试，死亡）和生活质量的改善。 将计算变异性和精度估计值（95％置信区间）。 AIM 3：探索认知因素（执行功能任务 绩效），寻求帮助以及自杀思维和行为在分期后通过面对面的一个月 访问和每日生态瞬时评估（EMA）。 意义。在过去的几年中，减少退伍军人自杀一直是VA的最高临床优先级。 但是，退伍军人的自杀总数继续增加。迫切需要 有针对性的治疗方法降低退伍军人自杀的风险。低成本，简单性和安全性 干预使交付和扩展到临床环境变得容易。如果该试点审判成功，它将设定 进行更大试验的阶段，以测试这种干预措施在高自杀中减少自杀事件的有效性 风险人口。