Treatment Seeking Study
Condition: Suicidal Ideation
MeSH terms: Suicidal Ideation
Study type: Interventional

Summary: 
      The study team conducted a randomized controlled clinical trial of 809 military service
      members who were at increased risk for suicide but not currently in behavioral health
      treatment. This study tested the effectiveness of a brief phone-based intervention (CBT-TS)
      aimed at changing military member's perceptions about behavioral health therapy. Participants
      completed five interviews over the course of one year to collect information about change in
      behavioral health symptoms and treatment utilization.
    

Detailed description: 
      Participants A randomized controlled trial design was used to test the efficacy of a brief,
      manualized, evidence-based CBT-TS to promote treatment initiation among at-risk military
      members and Veterans (W81XWH-13-2-0032; Increasing Treatment Seeking among At-Risk Service
      Members Returning from Warzones, funded by the Department of Defense). Participants were
      recruited through media advertisements. Ads targeted individuals who were considering help
      seeking. Eligible participants: 1) served in the US Armed Forces after September 11, 2001, 2)
      were not receiving behavioral health treatment at the time of the screening, and 3) endorsed
      recent suicidal ideation on the PHQ-9, item 9 (i.e., score of 1 or higher on the item) or a
      lifetime suicide attempt. Study procedures were reviewed and approved by the appropriate
      institutional review boards.

      Procedures Individuals deemed eligible after screening and who agreed to participate went
      through the informed consent process and were randomly assigned to either the control or
      CBT-TS condition. Participants were administered the baseline assessment with follow-up
      symptom and treatment utilization assessments occurring at months 1, 3, 6, and 12. All
      assessments were administered by telephone. Participants were compensated $25 for each
      assessment.

      Conditions:

      Cognitive Behavioral Treatment for Treatment Seeking. CBT-TS is a brief, manualized,
      phone-delivered, individual session lasting 45-60 minutes. CBT-TS targets a change in beliefs
      that influence whether someone enters treatment. A CBT-TS session has 4 distinct, successive
      stages. First, participants identify current symptoms. Second, participants describe
      strategies to manage symptoms. Third, beliefs about treatment are elicited. Fourth,
      participants discuss each stated belief. All participants were administered the same
      structured intervention; however, content discussed was personalized. For example, while
      participants may endorse similar beliefs about getting help (e.g., "Going to treatment would
      mean I am weak"), their ideas surrounding that belief and the meaning of it may differ.
      Therefore, while the intervention was structured, it allows for a personalized, tailored
      approach.

      Control condition. Participants assigned to the control condition did not receive the CBT-TS
      session. They were administered assessment measures at all time points comparable to the
      experimental group.

      Measures Demographic variables were assessed at baseline using a structured questionnaire.

      The Perceptions about Services Scale (PASS) was administered at baseline and is a 28-item
      self-report measure assessing beliefs about treatment and the extent to which they intend to
      initiate treatment. The PASS was originally developed to inform the development of the CBT-TS
      intervention and has good test-retest reliability.

      Measures of suicidal ideation, history of suicide attempt, and a range of clinical risk
      factors for suicidal ideation and behavior were obtained at baseline assessment to describe
      the sample, to facilitate a comparison of the CBT-TS and control group, and to guide any
      statistical adjustments that may be needed in the event of differences between groups.
      Suicidal ideation and suicide attempt were measured with the Columbia-Suicide Severity Rating
      Scale (C-SSRS). The C-SSRS is a widely used and validated semi-structured, rater-based
      interview designed to assess the severity and frequency of current and past suicidal ideation
      and behaviors. The C-SSRS has strong psychometric properties, has been validated for
      administration by phone, and has been used in prior research of suicidal behavior in
      Veterans. Clinical risk factors for suicidal thoughts and behavior were assessed using
      validated, widely used, brief, structured questionnaires including assessments of: the number
      of days of alcohol use (5+ drinks) and non-prescribed drug use in the past 30 days (Addiction
      Severity Index - Alcohol and Drug Scales [ASI];, pain, sleep disturbance (Insomnia Severity
      Index), thwarted belonging and perceived burdensomeness (Interpersonal Needs Questionnaire),
      depressive symptoms (Patient Health Questionnaire-9) and post-traumatic stress disorder
      symptoms (PTSD Checklist for DSM-IV Military Version2).

      Treatment utilization was assessed at months 1, 3, 6 and 12. There were two primary outcomes,
      treatment initiation to address suicidality or related conditions and the number of treatment
      sessions attended. Treatment initiation was assessed by asking participants if they had
      attended a mental health appointment. Data were collected as to the nature of the
      appointment, reason for the visit, whether they reported seeing a physician, psychologist, or
      other professional, and whether the session occurred at a VA facility or outside of VA. The
      other primary outcome, treatment sessions attended, was assessed by asking participants how
      many mental health treatment sessions they had attended.

      Logistic regression was used to assess treatment initiation, a categorical outcome. Latent
      growth curve modeling was conducted to assess treatment sessions attended, a continuous
      outcome.
    

Intervention name(s): Experimental: Cognitive Behavior Therapy; Active comparator: National Crisis Line
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants assigned to Group A were asked to participate in a talking session with a psychologist regarding thoughts about treatment. This session is designed to explore thoughts about behavioral health therapy for suicidality. The session was administered by phone, initially and again one month later. Participants discussed current functioning and their thoughts about seeking help with the goal of modifying thoughts about treatment. This phone session lasted approximately 45 to 60 minutes.; Participants assigned to Group B received information about the VA's National Crisis Line.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment