Facilitating use of the Veterans Crisis Line in High-Risk Patients

 描述(由申请人提供)： 退伍军人健康管理局(VHA)的患者致命和非致命自杀企图的风险显著增加，确定降低军人和退伍军人自杀行为风险的策略是国家的优先事项。退伍军人管理局在预防自杀方面投入了大量资金，作为这些努力的一部分；退伍军人危机热线被开发为退伍军人及其家人的重要资源。退伍军人危机热线自开通以来一直在稳步扩大，目前每月接到2万多个电话。尽管危机热线的利用率很高，但目前没有数据表明使用退伍军人危机热线是否会降低个人企图自杀或死亡的可能性，而且在随机对照试验中测试危机热线的有效性是不可行的，因为它在全国范围内向所有退伍军人及其家人开放。更重要的是，退伍军人危机热线可能无法触及那些自杀风险最大的人。我们的研究团队对最近在VHA住院精神病室接受自杀危机治疗的退伍军人进行了一项小型调查，发现不到一半的人使用过退伍军人危机热线，不到三分之一的人在过去一年内使用过它。因此，我们开发并收集了一项短暂干预的试点数据，旨在增加高危患者对退伍军人危机热线的利用，称为危机热线促进(CLF)。这一单次干预包括讨论患者在自杀发作期间对危机线使用的感知障碍。CLF会议结束时，患者拨打危机热线，治疗师在房间里，作为退伍军人练习拨打电话的后勤工作的一种方式，并有可能对抗任何关于退伍军人危机热线使用的负面看法的直接体验。这项拟议的研究将招募500名参与者，他们目前在VHA住院精神科接受自杀危机治疗，但最近没有使用退伍军人危机热线。这项研究将是一项随机对照试验，比较CLF和增强型日常护理(EUC)对退伍军人危机热线和其他心理健康服务的利用以及自杀企图的影响(S)。所有参与者将在基线后3个月、6个月和12个月进行重新评估。分析还将考察基线后危机线的使用在多大程度上中介了随机分配给CLF对随后自杀行为的影响。研究结束时的定性访谈将有助于了解未来实施CLF干预的障碍和促进者。如果成功，这项拟议的研究将提供关于短暂干预的潜在疗效的关键数据，该干预旨在改善现有资源--退伍军人危机热线--的利用，以减少VHA患者的自杀行为。制定一种简短而有效的方法来鼓励使用危机线有可能对VHA内的自杀率产生重大和实质性的影响，并可能被修改并输出到其他人口和环境中。

 DESCRIPTION (provided by applicant): Veterans Health Administration (VHA) patients are at a significantly elevated risk for fatal and non-fatal suicide attempts and identifying strategies to reduce the risk of suicidal behavior among members of the military and Veterans is a high national priority. The VHA has invested extensively in suicide prevention and, as part of these efforts; the Veterans Crisis Line was developed as an important resource for Veterans and their families. Utilization of the Veterans Crisis Line has expanded steadily since it first opened and, currently, it receives over 20,000 calls per month. Despite high utilization of the Crisis Line, no data are currently available on whether use of the Veterans Crisis Line reduces an individual's likelihood of a suicide attempt or death and it is not feasible to test the efficacy of the Crisis Line in a randomized controlled tril because it is nationally available to all Veterans and their families. More importantly, the Veterans Crisis Line may not reach those individuals at most acute risk for suicide. Our study team conducted a small survey of Veterans treated for recent suicidal crisis in a VHA inpatient psychiatric unit and found that less than half had ever utilized the Veterans Crisis Line and less than a third had used it within the past year. Consequently, we developed and gathered pilot data on a brief intervention designed to increase utilization of the Veterans Crisis Line among high risk patients, called Crisis Line Facilitation (CLF). This single-session intervention involve a discussion of the patient's perceived barriers of crisis line use during periods of suicidal criss. The CLF session ends with the patient calling the Crisis Line with the therapist in the room as a way for Veterans to practice the logistics of making the call and to have direct experiences that may counter any negative beliefs about Veterans Crisis Line use. The proposed study will recruit 500 participants who are currently treated for a suicidal crisis in VHA inpatient psychiatrc but have not recently used the Veterans Crisis Line. This study will be a randomized controlled trial of the impact of CLF compared to enhanced usual care (EUC) on utilization of the Veterans Crisis Line and other mental health services as well as suicide attempt(s). All participants will b re-assessed at 3-, 6- and 12- months post baseline. Analyses will also examine the extent to which post-baseline Crisis Line use mediates the effect of random assignment to CLF on subsequent suicidal behaviors. Qualitative interviews at the end of the study will help understand barriers and facilitators of future implementation of the CLF intervention. If successful, the proposed study will provide key data on the potential efficacy of a brief intervention to improve the utilization of an existing resource, the Veterans Crisis Line, to reduc suicidal behaviors in VHA patients. Developing a brief and effective approach to encourage use of the Crisis Line has the potential to have a significant and substantial impact on suicide rates within the VHA and could be modified and exported to other populations and settings.