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，如决策和冲动受损，已被认为是一种 在从自杀意念到自杀企图的转变过程中做出了重要贡献。为了应对……的流行 在美国老兵自杀后，我们建议测试一下可行性、可接受性和初步 五天经颅直流电刺激增强执行功能的效果 培训干预。这项干预措施将提供给自杀风险较高的住院患者 在自杀未遂后住院。最终目标是减少未来的自杀事件(构思， 尝试、死亡)和改善生活质量(例如社会关系、卫生资源利用)。 我们的干预结合了两种现有的干预措施：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证明可以增强大脑的可塑性和加速 学习。执行功能训练是一种行之有效的干预措施，可在临床上改善执行功能 人口。当tdcs与执行功能训练相结合时，学习率、执行功能、 与单纯的执行功能训练相比，转移到其他功能上的效果更好。 我们建议测试由10次tdcs组成的5天干预的可行性和可接受性。 自杀高危人群的强化执行功能训练：入院的退伍军人 在一次自杀未遂之后。住院患者在最初几周内自杀企图的风险最高 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期。此外，我们还将收集纵向和每日实时数据 出院后1个月求助、自杀风险及相关因素的生态瞬时研究 评估(EMA)。鉴于求助和自杀风险在本周波动，EMA提供了一个 对依赖于回顾和横断面方法的现有研究的改进。我们的目标是： 目的1：确定tdcs强化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，以 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 参与者的绩效数据，以评估培训练习的参与度和易用性。 目的2：评估干预对1)执行者行为治疗目标的初步效果 2)自杀事件(意念、企图、死亡)的减少和生活质量的提高。 将计算可变性和精确度估计值(95%可信区间)。 目标3：探索人与人之间和人内认知因素(执行功能任务)的变异性 行为)、求助、自杀念头和自杀行为 访问和每日生态瞬时评估(EMA)。 意义重大。在过去的几年里，减少退伍军人自杀一直是退伍军人管理局的首要临床任务。 然而，退伍军人的自杀总数仍在继续增加。迫切需要 降低退伍军人自杀风险的有针对性的治疗。低成本、简单性和安全性 干预使其易于交付和扩展到临床环境。如果这一试点试验成功，它将设置 为一项更大规模的试验做准备，以测试这种干预措施对减少高自杀率患者自杀事件的有效性 风险人群。