Acceptability and Feasibility of a Peer-to-Peer Firearm-Specific Means Safety Intervention

退伍军人的自杀率明显高于一般人群，超过两个- 其中三分之一是由枪支造成的。重要的是，研究表明，自杀死亡的风险是 当枪支被不安全地储存时（例如，没有锁定装置），这似乎 这在退伍军人中是一种常见的做法。致命手段咨询（LMC），一种促进安全的干预措施 在自杀危机期间，从家中储存和/或临时取出枪支， 提高安全储存的初步效果。然而，这种干预措施尚未在退伍军人中进行测试。 人口此外，一些文化和后勤障碍可能会阻碍退伍军人获得相同的 与其他人群一样受益，包括退伍军人自我披露自杀想法的可能性低， 动机（即，相信谈话是对枪支管制的一种含蓄的尝试），并表示对这种 讨论发生在枪支拥有者或退伍军人，而不是临床医生。因此， 拟议的职业发展奖-1（CDA-1）是适应和扩大现有的LMC干预同行， 拥有枪支的退伍军人之间的传递。适应将涉及召集一个由退伍军人和非退伍军人组成的小组， 资深专家将提供干预和干预人员培训方面的投入， 需要适应。退伍军人干预者和退伍军人参与者将通过东南部招募 路易斯安那州退伍军人医疗保健系统（SLVHCS），更广泛的社区，以及现有的网络， 由退伍军人知情安全干预和外联网络（VISION）建立的联系人-一组 社区和退伍军人利益相关者促进退伍军人自杀预防。经验丰富的干预者将 在进行适应性干预方面进行了培训，并将与至少15名拥有枪支的退伍军人进行试点。 然后，通过使用自我报告，评估干预措施的初步可行性和可接受性 问卷调查和定性访谈。在整个CDA-1期间，我希望发展退伍军人的技能- 从事研究和定性方法，这将促进我的发展，作为一个自杀预防 研究员我将与我的主要导师密切合作，他在这些研究方面具有广泛的专业知识 方法，并将完成正式的教学课程和网络研讨会上这些主题。个人也愿意 通过传统的大学教育，提高与随机对照试验（RCT）设计和分析相关的技能 课程作业、结构化咨询和指导。拟议的研究将提供重要的经验， 用这些方法对待退伍军人。来自拟议研究的数据将用于支持职业生涯 发展奖-2（CDA-2）申请，这将涉及一项RCT，调查同行- 在退伍军人中提供LMC。因此，这个奖项将为我的长期工作提供非凡的准备。 职业目标是成为退伍军人事务部的独立临床科学家。

The suicide rate among Veterans is significantly higher than that of the general population, with more than two- thirds of these deaths resulting from firearms. Importantly, research suggests that risk for suicide death is significantly higher when firearms are stored unsafely (e.g., loaded, without a locking device), which appears to be a common practice among Veterans. Lethal means counseling (LMC), an intervention promoting safe storage and/or temporary removal of firearms from the home during times of suicidal crisis, has demonstrated initial effectiveness for increasing safe storage. However, this intervention has yet to be tested in a Veteran population. Furthermore, several cultural and logistical barriers may impede Veterans from obtaining the same benefit as other populations, including low probability of Veterans self-disclosing suicidal thoughts, mistrust of motive (i.e., belief that the conversation is a veiled attempt at gun control), and preference indicated for such discussions to occur with fellow firearm owners or Veterans, as opposed to clinicians. Thus, the purpose of the proposed Career Development Award-1 (CDA-1) is to adapt and expand an existing LMC intervention for peer- delivery among firearm owning Veterans. Adaptation will involve convening a panel of Veteran and non- Veteran experts who will provide input on aspects of the intervention and interventionist training that may require adaptation. Veteran interventionists and Veteran participants will be recruited through the Southeast Louisiana Veterans Health Care System (SLVHCS), the broader community, and an existing network of contacts established by the Veteran Informed Safety Intervention and Outreach Network (VISION) – a group of community and Veteran stakeholders promoting Veteran suicide prevention. Veteran interventionists will be trained in conducting the adapted intervention and it will be piloted with at least15 firearm owning Veterans. This intervention will then be evaluated for initial feasibility and acceptability through use of self-report questionnaires and qualitative interviews. Throughout the CDA-1 period, I hope to develop skills in Veteran- engaged research and qualitative methodology, which will bolster my development as a suicide prevention researcher. I will work closely with my primary mentor, who has extensive expertise in these research approaches, and will complete formal didactic coursework and cyber-seminars on these topics. I also hope to sharpen skills related to randomized controlled trial (RCT) design and analysis through traditional university coursework, structured consultation, and mentorship. The proposed study will provide vital experience implementing these approaches with Veterans. Data from the proposed study will be used to support a Career Development Award-2 (CDA-2) application, which would involve a RCT investigating the efficacy of peer- delivered LMC among Veterans. Thus, this award would provide extraordinary preparation for my long-term career goal to become an independent clinical scientist in the Department of Veterans Affairs.