Development of a Novel Couples-Based Suicide Intervention: Treatment for Relationships and Safety Together (TR&ST)

背景：自杀是美国和世界范围内的主要死因之一，与自杀并列 美国退伍军人的比率(27.7/10万)是平民水平(14.7/10万)的两倍。 尽管预防工作有所增加，但发病率仍在继续上升。自杀与康复理论 心理学强调人与环境的相互作用在导致残疾方面的重要性 经验。具体地说，研究一直发现，自杀最常见的诱因是 和一个浪漫的伴侣有问题。相反，人际关系良好的人不太可能有 自杀的念头。《国际功能、残疾和健康分类》(ICF)确定了 参与和沟通是运作的重要组成部分。预防高危人群自杀 退伍军人至关重要，亲密关系的质量是一种研究不足的干预 自杀预防的目标。这项建议提炼和评估了第一对夫妇的初步疗效 针对自杀的干预--关系和安全的共同治疗(TR&ST)。 意义/创新：预防自杀是退伍军人事务部/国防部的首要临床任务。重要的是包括 退伍军人自杀相关护理中的家庭成员是国家预防战略的重要组成部分 2018-2028年退伍军人自杀事件和2019年退伍军人/国防部患者焦点小组的主要发现 退伍军人事务部/国防部评估和处理有自杀危险的患者的临床实践指南。 CDA-2提案的创新方面直接涉及国家报告的几个组成部分，包括： 1)第一个以夫妻为基础的自杀特异性干预和第一个以自杀为目标的特异性干预 自杀理论和康复心理学确定的人际功能因素(即有效的 沟通和人际接触)；2)以退伍军人为中心的选择 卫生和基于办公室的护理，以增加获得机会；以及3)提高退伍军人的数据分析质量 通过检查退伍军人和伴侣关于自杀相关风险因素的报告(第一次自杀- 做这件事的具体治疗研究)。 研究方法：拟议的为期5年的研究包括两个阶段。阶段1：通过10次治疗进行改进 配对(N=20)和阶段2：RT&ST与VA标准对照的试点随机对照试验 自杀干预60对夫妇(N=120)。干预期为13周，整个研究期 大约7个月。这两个阶段的夫妇都将在基线、治疗中期、 治疗后和治疗后3个月(并在每个TR&ST模块之后进行定性访谈)。 要评估的主要结果是自杀意念严重程度的变化。次要结果令人担忧 人际功能的变化。 目标：目标1(阶段1)：在一群有积极自杀意念的退伍军人中提炼tr&st。目标2(阶段 2)：评价RT&ST治疗的可行性和可接受性。目标3(阶段2)：将TR&ST与VA进行比较 自杀意念严重性和人际功能的标准自杀干预(即，沟通， 亲密度、关系满意度、归属感和负担)超过7个月。 下一步：这个职业发展奖是向发展一个重要的研究项目迈出的第一步 在VHA内，专注于通过让家庭参与来增强人际功能和自杀相关护理 正在接受治疗的成员。如果目标得以实现，未来的工作包括：1)建立一个有足够动力的RT&ST RCT VS VA标准自杀干预2)更直接地评估基于夫妇或家庭的远程健康 参与针对自杀的干预措施，以及3)审查主持人或感兴趣的团体(例如 女退伍军人)。

Background: Suicide is one of the leading causes of death in the United States and worldwide, with suicide rates among U.S. military veterans doubling (27.7 per 100,000) the rate of civilian levels (14.7 per 100,000). Despite a rise in prevention efforts, rates have continued to increase. Theories of suicide and rehabilitation psychology stress the importance of the person-environment interaction in contributing to one’s disability experience. Specifically, research has consistently found that the most frequent precipitant of suicide is a problem with a romantic partner. Conversely, people with better relationship functioning are less likely to have suicidal thoughts. The International Classification of Functioning, Disability and Health (ICF) identifies social engagement and communication as important components of functioning. Prevention of suicide in at-risk veterans is of vital importance and the quality of one’s intimate relationship is an understudied intervention target for suicide prevention. This proposal refines and evaluates preliminary efficacy of the first couples-based suicide-specific intervention—Treatment for Relationships and Safety Together (TR&ST). Significance/Innovation: Suicide prevention is the top clinical priority for VA/DoD. The importance of including family members in Veterans’ suicide-related care is a critical component of the National Strategy for Preventing Veteran Suicides 2018-2028 and key finding from VA/DoD patient focus groups conducted for the 2019 VA/DoD Clinical Practice Guidelines for the Assessment and Management of Patients at Risk for Suicide. Innovative aspects of this CDA-2 proposal directly address several components of national reports and include: 1) The first couples-based suicide-specific intervention and the first suicide-specific intervention to target interpersonal functioning factors identified by suicide theories and rehabilitation psychology (i.e., effective communication and interpersonal engagement); 2) Veteran-centric choice between home-based telemental health and office-based care in order to increase access; and 3) Improved data analytic quality of Veteran suicidality by examining both Veteran and partner reports of suicide related risk factors (the first suicide- specific treatment study to do this). Methodology: The proposed 5-year study consists of two phases. Phase 1: treatment refinement with 10 couples (N=20) and Phase 2: pilot Randomized Controlled Trial (RCT) of TR&ST compared to VA Standard Suicide Intervention with 60 couples (N=120). The intervention period is 13 weeks and the entire study period is approximately 7 months. Couples in both phases will be quantitatively assessed at baseline, mid-treatment, post-treatment, and 3-months post-treatment (and qualitatively interviewed following each TR&ST module). The primary outcome to be evaluated is change in suicidal ideation severity. Secondary outcomes concern changes in interpersonal functioning. Aims: Aim 1 (Phase 1): Refine TR&ST in a population of Veterans with active suicidal ideation. Aim 2 (Phase 2): Evaluate treatment feasibility and acceptability of TR&ST. Aim 3 (Phase 2): Compare TR&ST vs. VA Standard Suicide Intervention on suicidal ideation severity and interpersonal functioning (i.e., communication, bonding, relationship satisfaction, and belonginess and burdensomeness) over 7 months. Next Steps: This Career Development Award is the first step toward developing a vital program of research within VHA focused on enhancing interpersonal functioning and suicide-related care by involving family members in treatment. If Aims are achieved, future work includes 1) an adequately powered RCT of TR&ST vs. VA Standard Suicide Intervention 2) a more direct evaluation of telehealth for couples-based or family involvement in suicide-specific interventions, and 3) examination of moderators or groups of interest (such as women Veterans).