SAFER: A brief intervention involving family members in suicide safety planning

尽管丰富了退伍军人事务部自杀预防服务， 自杀热线，退伍军人自杀完成已上升到每天22和自杀企图 2012年超过1.5万人。这些数据表明，迫切需要开发新的 针对自杀退伍军人的干预措施。进一步自杀治疗的一个潜在途径， 康复工作是制定战略，最大限度地提高家庭的支持，但几乎没有 对自杀的退伍军人进行家庭干预。自杀安全计划（SSP） “最佳实践”是整个VA系统的强制性要求，也是VA的重要组成部分 协调自杀预防和康复工作。我们的试点数据的模式SSP使用， 自杀退伍军人强调与家人或亲密朋友分享计划的重要性。 然而，答卷人也指出，他们在与他人接触方面存在重大障碍 在危难时。据我们所知，目前没有推荐的指南或 尽管家庭参与安全计划是计划的一个步骤，但缺乏使家庭参与安全计划的机制。 “鼓励家庭康复的安全行动”（SAFER）是一种新型的自杀安全计划 家庭干预旨在填补这一关键空白，并提供一种机制， 沟通安全规划。SAFER，一个4节，家庭干预，结合 有关自杀和自杀安全计划的教育，以及沟通技巧培训， 循证实践。目的是促进有关自杀安全计划的沟通 并制定退伍军人和家庭成员安全计划。 本项目的数据将检验干预的可行性、可接受性和初步效果 在一项II期（Rounsaville et al，2001）小规模随机临床试验中，60例中度自杀者 风险退伍军人及其家属。比较条件为安全规划 没有家人的参与，每周都打电话报到主要退伍军人结局包括 减少自杀意念/行为。次要退伍军人结局包括减少自杀 认知（绝望，感知负担，挫败感）和 改善主观社会支持。家庭成员主要结局包括 减少照顾者负担和改善自杀相关应对的次要结局， 家庭赋权。

Despite the enrichment of VA suicide prevention services and implementation of the national suicide hotline, Veteran suicide completions have risen to 22 per day and suicide attempts numbered over 15,000 in 2012. These data underscore the urgency of developing additional interventions targeting suicidal Veterans. One potential avenue to further suicide treatment and rehabilitation efforts is to develop strategies that maximize family support, however almost no family interventions exist for suicidal Veterans. The construction of a Suicide Safety Plan (SSP); a “best practice,” is mandated throughout the VA system, and a vital component of the VA’s coordinated effort at suicide prevention and recovery. Our pilot data on patterns of SSP use in suicidal Veterans highlighted the importance of sharing the plan with family or close friends. However, respondents also noted significant obstacles in their ability to reach out to others when in distress. To our knowledge, there are currently no recommended guidelines or mechanisms for involving family in safety planning, despite its inclusion as a step of the plan. “Safe Actions for Families to Encourage Recovery” (SAFER) a novel suicide safety planning family intervention has been designed to fill this critical gap and provide a mechanism to communicate about safety planning. SAFER, a 4-session, family intervention, combines education about suicide and suicide safety planning with communication skills training from evidence-based practices. The aim is to facilitate communication about suicide safety planning and to develop both a Veteran and family member safety plan. Data from this project will test the intervention’s feasibility, acceptability and preliminary efficacy in a Stage II (Rounsaville et al, 2001) small-scale randomized clinical trial in 60 moderate suicide risk Veterans and their family members. The comparison condition will be safety planning without family involvement plus weekly check-in phone calls. Primary Veteran outcomes include reducing suicidal ideation/behavior. Secondary Veteran outcomes include reducing suicidal cognitions (hopelessness, perceived burdensomeness, thwarted belongingness) and depression and improving subjective social support. Family member primary outcomes include reducing caregiver burden and secondary outcomes of improving suicide-related coping and family empowerment.