Caring Cards to and from Veterans: Feasibility and Acceptability of a Peer Approach toSuicide Prevention and Recovery

这项建议是为了响应RR&D的康复研究小项目奖(SPIRE)。有一种强烈的 需要开发、评估和实施旨在减少退伍军人自杀的可翻译干预措施。关爱 预防自杀联系人(即，工作人员在精神病住院患者之后向患者发送支持信 STESS)是一种有经验支持的低成本方法，可有效降低自杀风险和住院 已在退伍军人/退伍军人管理局的环境中进行了研究和应用。同伴支持(即生活在一起的人 心理健康康复中的心理健康体验)是另一种得到经验支持的方法。同行的 参与精神保健可以改善患者的社会功能和社区融合度，以及 减少自我羞辱和功能损伤。该提案描述了关爱卡(CC)干预， 这是一种关爱联系人和同龄人的新颖整合。在CC，有精神健康生活的门诊退伍军人 经验(同行)创建充满希望和鼓舞人心的卡片，然后将这些卡片发送给其他正在与 心理健康问题。通过设计，CC增加了参与者之间的社交联系，以减少自杀 风险，这与社会脱节密切相关。事实上，有两种基于证据的社会风险 自杀因素：归属感受挫(结核病；感觉自己不属于)和被感知 负担(PB；感觉自己的存在是别人的负担)。CC将两者的关怀结合在一起 接触者和同龄人通过增加社会联系来明确减少结核病和肺结核的目标。本研究 旨在确定CC的可行性和可接受性。我们最初的质量改进项目提供了 CC的可行性和可接受性的强有力的初步证据。目前的建议是单一的- 网站，为期2年的试点试验，采用开放试验、前/后研究设计。我们建议招收门诊病人 有高自杀风险历史的退伍军人组成我们的CC小组并担任制卡人(CMS)。我们 将招募目前自杀风险高的门诊退伍军人作为我们的收卡人(CRS)。这个 主要成果(目标1)是确定CC的可行性和可接受性。目标2将检查CC的能力 减少我们在CMS和CRS中的主要结局(结核病和PB)。目标3将初步评估CC的能力 增加社会联系，减少CMS中的自杀风险(即自杀念头和行为) 和CRS。CMS将以每周小组的形式开会，每个小组为期六个月，为期一年；CRS将收到 一共六张卡，每月一张。每月聚会小组也将是CMS和CRS的可选场所 面对面地见面。基线和后续评估将在开始时和一个月后完成 CMS的最终小组，或CRS的最终卡后一个月。这个项目建立在我们初步数据的基础上 这表明资深CMS对CC组感兴趣并认为参与CC组非常有意义，以及 资深CRS喜欢收到卡片，希望收到更多，并将它们描述为鼓舞人心和 令人振奋。该项目在利用同龄人促进自杀预防和社交方面具有创新性 在有自杀风险的退伍军人中，通过特别针对结核病和PB进行康复。它的独特之处还在于它 同时瞄准两个人群(有自杀病史的门诊退伍军人和目前自杀的退伍军人 风险)，以前没有通过传统的关怀接触者进行检查。这项研究直接 响应国家预防自杀优先研究议程。这项研究直接支持 RR&D的使命，并与退伍军人管理局2018-2028年防止退伍军人自杀的国家战略保持一致。我们 预计这些数据将为高危退伍军人预防自杀和社会康复的最佳做法提供参考 自杀的罪名。

This proposal responds to RR&D's Small Projects in Rehabilitation Research Award (SPiRE). There is a strong need to develop, evaluate, and implement translatable interventions aimed at reducing Veteran suicide. Caring contacts for suicide prevention (i.e., staff send supportive letters to patients following psychiatric inpatient stays) is an empirically supported, low-cost method for meaningfully reducing suicide risk and hospitalization readmissions and, has been studied and applied in Veterans/VA settings. Peer support (i.e., persons with lived mental health experience) in mental health recovery is another empirically supported approach. Peers' involvement in mental healthcare improves patients' social functioning and community integration, as well as reduces self-stigma and functional impairment. This proposal describes the Caring Cards (CC) intervention, which is a novel integration of caring contacts and peers. In CC, outpatient Veterans with lived mental health experience (peers) create hope-filled and inspiring cards that are then sent to other Veterans struggling with mental health concerns. By design, CC increases social connectedness among participants to reduce suicide risk, which is strongly associated with social disconnectedness. Indeed, there are two evidence-based social risk factors of suicide: thwarted belongingness (TB; feeling like one does not belong) and perceived burdensomeness (PB; feeling as though one's existence is a burden on others). CC combines both caring contacts and peers to specifically target reductions in TB and PB by increasing social connectedness. This study aims to establish the feasibility and acceptability of CC. Our initial quality improvement project provided strong preliminary evidence for the feasibility and acceptability of the CC. The current proposal is for a single- site, 2-year pilot trial that employs an open-trial, pre/post research design. We propose to recruit outpatient Veterans with a history of high suicide risk to make up our CC group and serve as the card-makers (CMs). We will recruit outpatient Veterans who are currently at high-risk for suicide to be our card-recipients (CRs). The primary outcome (Aim 1) is to establish feasibility and acceptability of CC. Aim 2 will examine CC's ability to reduce our primary outcomes (TB and PB) among CMs and CRs. Aim 3 will preliminary evaluate CC's ability to increase social connectedness, as well as reduce suicide risk (i.e., suicidal ideation and behavior) among CMs and CRs. CMs will meet in weekly groups, each for six months, over the course of one year; CRs will receive a total of six cards, one per month. Monthly meetup groups will also be an optional venue for CMs and CRs to meet each other in-person. Baseline and follow-up assessments will be completed at start and one month after final group for CMs, or one month after the final card for CRs. This project builds on our preliminary data which indicate that Veteran CMs are interested in and find participating in CC groups highly meaningful, and Veteran CRs enjoy receiving the cards, want to receive more, and describe them as inspirational and empowering. This project is innovative in its utilization of peers to facilitate suicide prevention and social recovery among Veterans at risk for suicide by specifically targeting TB and PB. It is also unique in that it simultaneously targets two populations (outpatient Veterans with a history of, and those with current suicide risk), which have not previously been examined with traditional caring contacts. This research directly responds to the National Prioritized Research Agenda for Suicide Prevention. This study directly supports RR&D's mission and is aligned with VA's 2018-2028 National Strategy for Preventing Veteran Suicide. We expect that these data will inform best practices in suicide prevention and social recovery for Veterans at risk for suicide.