Group (“Project Life Force”) vs. Individual Suicide Safety Planning RCT

尽管丰富了退伍军人事务部自杀预防服务， 自杀热线，退伍军人自杀完成每天发生20次，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。自杀安全计划（SSP）; “最佳实践”是整个VA系统的任务，也是VA的重要组成部分。 协调自杀预防和康复工作。退伍军人的安全规划 急诊室已经被证明可以减少自杀行为。据我们所知， 目前没有推荐的指南或机制来完善成人SSP 超越了最初的发展。“生命力计划”（PLF），一种新型的自杀安全 规划小组的干预措施旨在填补这一关键空白，并提供一种机制， 发展和加强自杀安全规划。PLF，10次会议，小组 心理治疗干预，结合辩证行为疗法（DBT）的技能为基础， 心理教育方法，以加强自杀安全规划的发展， 实施.退伍军人在学习痛苦的同时，在几周内修改他们的计划 宽容，情绪调节，和友谊建设/人际交往技能，以纳入他们的 安全计划，并接受有关枪支安全和尽量减少使用致命手段的课程， 增强身体健康和战略如何分享他们的计划与家庭/重要 其他人和他们的治疗团队。重要的是，小组形式减轻了孤独感， 增加的“自杀倾向”，这两个都是自杀的关键风险因素。此外，PLF的每周格式 促进VA授权的监测任何退伍军人放在自杀“高风险”名单。PLF 2015年获得VA康复和研究发展部的SPiRE试点资金， 完成干预手册的编写工作，并在退伍军人中试行干预措施。 初步数据表明，可行性和可接受性很高。100%参与者 制定了更新的安全计划，增加了使用模式， 自杀意念 该项目的目的是进行多站点（詹姆斯J彼得斯VAMC和费城VA） PLF与常规治疗（TAU）的随机临床试验（RCT），包括个体 对265名自杀退伍军人的安全计划进行电话审查，并随访一年。的 主要结局变量是自杀行为，使用严格的多方法评估 随访次要结局包括抑郁、绝望和治疗利用。 探索性分析将检查自杀应对和群体水平的变化是否 PLF内聚介导治疗反应。方法上的严格性包括持续的依从性 由独立的第三方机构（哥伦比亚）对PLF和评估培训/监测进行评级 大学）。

Despite the enrichment of VA suicide prevention services and implementation of the national suicide hotline, Veteran suicide completions occur 20 times per day and suicide attempts numbered over 15,000 in 2012. These data underscore the urgency of developing additional interventions targeting 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. Safety Planning in Veterans presenting to an emergency room has been shown to decrease suicide behavior. To our knowledge, there are currently no recommended guidelines or mechanisms for refinement of the SSP in adult populations beyond its initial development. “Project Life Force” (PLF), a novel suicide safety planning group intervention has been designed to fill this critical gap and provide a mechanism to develop and enhance suicide safety planning over time. PLF, a 10-session, group psychotherapy intervention, combines Dialectical Behavioral Therapy (DBT) skill based and psychoeducational approaches, to enhance suicide safety planning development and implementation. Veterans revise their plans over several weeks while learning distress tolerance, emotion regulation, and friendship building/interpersonal skills to incorporate into their safety plans and also receive lessons on gun safety and minimizing access to lethal means, augmenting physical well being and strategies how to share their plan with family/significant others and their treatment team. Importantly, the group format mitigates loneliness and fosters increased “belongingness,” both key risk factors for suicide. Additionally, PLF’s weekly format facilitates VA-mandated monitoring for any Veteran placed on the suicide “high risk” list. PLF received pilot SPiRE funding from the VA Rehabilitation and Research Development in 2015 to finalize the development of the intervention’s manual and pilot the intervention in Veterans. Preliminary data suggests high levels of feasibility, and acceptability. 100% of participants developed updated safety plans and increased use patterns and a significant decrease in suicidal ideation. This project’s aim is to conduct a multi-site (James J Peters VAMC and Philadelphia VA) randomized clinical trial (RCT) of PLF versus treatment as usual (TAU) that includes individual telephone review of safety plans in 265 suicidal Veterans with follow up to one year. The primary outcome variable is suicidal behavior, using a rigorous, multi-method assessments follow-up. Secondary outcomes include depression, hopelessness and treatment utilization. Exploratory analyzes will examine whether changes in suicide coping and levels of group cohesion in PLF mediate treatment response. Methodological rigor includes ongoing adherence ratings for PLF and assessment training/monitoring by an independent third site (Columbia University).