Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effectiveness and Implementation of a Peer Mentorship Intervention (PREVAIL) to Reduce Suicide Attempts Among High-Risk Adults
Brief Summary: Amid consistently worsening suicide rates, in 2012 the U.S.Surgeon General's National Strategy for Suicide Prevention proposed to "change the narrative" about suicide prevention to include a focus on promoting hope and belongingness. Despite hopelessness and thwarted belongingness being among the most replicated risk factors for suicide, many widely implemented suicide prevention efforts instead emphasize the identification of acute suicide risk and referral to mental health treatment services. However, there are very few health service interventions known to reduce suicides among those identified as high risk. Those interventions shown to be effective have not achieved the wide scale implementation necessary to alter the trend of increasing suicide deaths. New interventions are needed, and one promising, scalable intervention with a novel approach to addressing the risk factors advocated by the Surgeon General is peer mentorship. A peer mentorship intervention, PREVAIL, has been piloted in a two-site randomized controlled trial (N=70) and is acceptable and feasible with enrollment of nearly half of eligible high-risk patients, mean completion of over 6 mentorship sessions, and 85% of sessions meeting fidelity standards for addressing the intended targets of hope and belongingness.

The aims of this hybrid effectiveness-implementation study are:

Specific Aim 1: Determine the effectiveness of the PREVAIL peer mentorship intervention for reducing suicide attempts and suicidal ideation among recently hospitalized adult psychiatric patients at high risk for suicide.

Specific Aim 2: Examine the mechanisms of peer mentorship by measuring the effects of PREVAIL on potential mediators,including hope and belongingness.

Specific Aim 3: Identify barriers and facilitators to implementation of PREVAIL.


Options:
A: Inclusion Criteria:

* Diagnosed with BPD or PTSD, with a structured interview according to the current diagnostic manual
* In behavioral crisis

Exclusion Criteria:

* Brain damage
* Currently intoxicated with alcohol or drugs or in withdrawal
B: Inclusion Criteria:

1. are age 18 years or older,
2. are currently admitted to an inpatient psychiatric unit and have medical record documentation of suicidal ideation or suicide attempt at the time of admission,
3. have a Beck Suicide Scale score of 5 or higher for the 1-week period prior to admission,
4. are fluent in English,
5. are able to be reached reliably by telephone.

Exclusion Criteria:

1. substantially cognitively impaired (according to the Mini-Cog),
2. unable to provide informed consent for any reason (including incompetency),
3. determined by the patient's attending psychiatrist that peer mentorship is not appropriate due to unstable psychosis, cognitive disorder, or severe personality disorder,
4. already receiving or intending to receive peer mentorship (i.e., sponsor from Alcoholics Anonymous) or group-based peer support on a biweekly or more frequent basis,
5. residing more than 50 miles from any peer mentor,
6. planning to be discharged to another inpatient or residential facility, or
7. receiving electroconvulsive therapy
C: Inclusion Criteria:

* Surviving to a suicide attempt (SA) directly leaving the Emergency unit or have been hospitalized less than 7 days

Exclusion Criteria:

* recidivists who made 4 SA and more in the 3 past years
D: Inclusion Criteria:

* Adults with a high level of impulsivity (with or without ADHD) based on a CGI-S-score ≥ 4.
* An Affective Reactivity Index (ARI) score ≥5 indicating a high level of multi dimensional impulsivity.
* Research diagnosis of attention-deficit/hyperactivity disorder (ADHD) and/or borderline personality disorder (BPD) confirmed by structured diagnostic interview according to DSM-5 (ADHD: Diagnostic Interview for Adult ADHD (DIVA 2.0); BPD: Structured Clinical Interview for DSM-IV (SCID-II)).
* Not currently taking any antibiotics or probiotics.
* Deemed reliable and compliant with the protocol by the investigator.
* Ability to speak and comprehend the native language of the country in which the assessments take place.

Exclusion Criteria:

* Subject is being treated with a concomitant medication which is prohibited within this study according to the list of prohibited medications.
* Patients must be on stable medication (i.e. current dose is given since more than 30 days): up-titration is not allowed and careful clinical screening is done at all visits to check whether lower dosage is needed due to increased side effects as a result of treatment with Synbiotic2000Forte.
* Presence of major psychiatric disorders with psychotic's symptoms.
* Neurological disorder involving brain or other central function (e.g., intellectual disability with an assessed IQ \< 70, epilepsy, MS, narcolepsy) or other major psychiatric condition requiring hospitalization (e.g., significant mood disorder or psychosis).
* Major physical illness of the cardiovascular, endocrine, pulmonal, or the gastrointestinal system.
* History of or present clinically relevant somatic acute or chronic disorder that, in the opinion of the investigator, might confound the results of tolerability/safety assessment, or prohibit the patients from completing the study, or would not be in the best interest of the patient.
* Subject has a documented allergy, hypersensitivity, or intolerance to any of the ingredients of the intervention.
* Subject has taken another investigational product or taken part in a clinical study within 30 days prior to entering the study.

Answer: B