Please select the eligibility criteria that correspond to the clinical trial below.
Title: Caring Letters for Military Suicide Prevention: A Randomized Controlled Trial
Brief Summary: The purpose of this multi-site randomized controlled trial is to determine if the Caring Letters intervention is effective in preventing suicide and suicidal behaviors among U.S. Service Members and Veterans. The primary aim of this project is determine whether caring communications following inpatient psychiatric treatment reduce suicide and self-inflicted injuries among U.S. military personnel and Veterans. The investigators will also explore treatment utilization by comparing the frequency of treatment visits after enrollment into the study. The following specific hypotheses will be tested:

Hypothesis 1: During a two year follow-up after the index hospital discharge, the frequency of suicide will be lower among participants in the Caring Letters group compared to those in the Usual Care group.

Hypothesis 2: The frequency of medically admitted self-inflicted injuries will also be lower in the Caring Letters group compared to the Usual Care group.

Hypothesis 3: The time to suicidal act, among those who do subsequently exhibit one, will be longer among participants in the Caring Letters group compared to the Usual Care group.


Options:
A: Inclusion Criteria:

* At least 18 years old
* Engage in non-suicidal self-injury (NSSI) to reduce or lessen negative thoughts or feelings
* Not taking psychotropic medications, or meet criteria for stability on a particular dose and are willing to maintain a stable dosage throughout the study
* Meet the proposed Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for NSSI disorder, which includes:

  1. five or more days in which the individual has engaged in NSSI in the past year
  2. NSSI is associated with at least two two of the following: psychological precipitant (e.g., negative feelings or thoughts), urge prior to the act, preoccupation with NSSI, contingent response (e.g., expectation that the act will relieve a negative feeling state)
  3. clinically significant distress or interference caused by NSSI or its consequences
  4. NSSI does not occur exclusively during states of psychosis, delirium, or intoxication
  5. absence of suicidal intent

Exclusion Criteria:

* Current suicidal ideation and intent
* Currently receiving cognitive-behavioral therapy (CBT) or any psychotherapy to address NSSI, anxiety, depression, or other Axis I disorders (and are not willing to discontinue that treatment)
* Unwilling to refrain from initiating additional treatment during the course of the study
* Current or very recent symptoms that warrant immediate clinical attention, alternative treatment, and/or a higher level of care that cannot be provided through the study (e.g., florid delusions or hallucinations, rapid mood state, severe manic symptoms)
* Current or recent (within 3 months) history of substance use disorder (exception would be marijuana, caffeine, nicotine)
* Emotional symptomatology is due to a medical/physical condition
B: Inclusion Criteria:

1. 18 years or older.
2. Suicide attempt within the past 60 days defined by intent to die using a standard item.
3. Ability and willingness to provide information and permission to contact at least one person in the case of a need to contact them to promote subject safety or inability to reach the subject for follow-up.

Exclusion Criteria:

1. Acute psychiatric instability (e.g., psychotic symptoms).
2. Inability to communicate in English (ASSIP is only provided by the clinic in English).
3. Residing outside of NYS (during the period eligible for ASSIP)
C: Inclusion Criteria:

* Current psychiatric inpatients
* Possess an active email account
* Informed consent
* Active duty military, Veteran, Retiree, National Guard or Reserves status

Exclusion Criteria:

* Not competent to consent
* Adverse behavioral problems
* The primary psychiatric nurse or attending psychiatrist considers that study to be clinically inappropriate
* Currently under arrest/incarceration
* Involuntary committed for psychiatric care status
D: Inclusion Criteria:

* Female
* Age 18-60
* Meet criteria for borderline personality disorder
* Meet criteria for post-traumatic stress disorder
* Can clearly remember at least some part of the traumatic event(s)
* Recent and recurrent self-injurious behavior
* Lives within commuting distance of University of Washington, Seattle campus
* Consents to all research protocols

Exclusion Criteria:

* Male
* Court ordered to treatment
* Diagnosis of psychotic disorder, bipolar disorder, or seizure disorder requiring medication
* Less than 18 years of age or older than 60 years of age
* Problems which by their presence or severity preclude ability to attend or understand treatment and/or requires priority treatment
* Familial or domestic relationship with a current study participant

Answer: C