Brief Interventions for Short-Term Suicide Risk Reduction in Military Populations
Condition: Suicide; Suicidal Ideation
MeSH terms: Suicide; Suicidal Ideation
Study type: Interventional

Summary: 
      The purpose of the proposed study is to identify the most effective brief interventions for
      reducing short-term risk for suicide attempts in "real world" military triage settings, and
      to identify potential mechanisms of change underlying the interventions' impact on subsequent
      suicide attempts. We will randomize 360 patients to one of three commonly-used crisis
      interventions delivered as routine care in the mental health triage system: (1) Treatment As
      Usual (TAU); (2) Standard Crisis Response Plan (S-CRP); or (3) Enhanced Crisis Response Plan
      with Reasons For Living (E-CRP). The following hypotheses will be tested:

        1. The enhanced crisis response plan (E-CRP) intervention will contribute to significantly
           decreased risk for suicide attempts and hospitalization during follow-up relative to the
           standard crisis response plan alone (S-CRP) and treatment as usual (TAU).

        2. The standard crisis response plan (S-CRP) intervention will contribute to significantly
           decreased risk for suicide attempts and hospitalization during follow-up relative to
           treatment as usual (TAU).

        3. Greater ambivalence about suicide and faster recall of reasons for living will mediate
           the relationship between intervention and reduced risk for suicide attempt during
           follow-up.
    

Detailed description: 
      The CRP has been proposed as an alternative to TAU for the short-term management of suicidal
      patients and is now in widespread use, but has never been empirically tested. The CRP is
      purported to reduce suicide risk via unique mechanisms that directly suicide risk, notably
      suicidal ambivalence (i.e., the relative balance between the wish to live and the wish to
      die) and problem solving. Because suicidal ambivalence has gained support as an active
      mechanism for reducing suicide risk, the present study will also seek to augment this
      underlying mechanism by directly engaging the suicidal patient in a discussion about their
      reasons for living, thereby potentially increasing the potency of the CRP.

      The present study therefore entails a component analysis of crisis interventions. As such, we
      anticipate ordered effects, whereby the S-CRP and E-CRP conditions will show significantly
      better outcomes than TAU, and E-CRP will demonstrate significantly better outcomes than the
      standard CRP condition.
    

Intervention name(s): Treatment As Usual (TAU); Standard Crisis Response Plan (S-CRP); Enhanced Crisis Response Plan (E-CRP)
Intervention type(s): Behavioral; Behavioral; Behavioral
Other intervention name(s): Usual Care; Enhanced Care; Enhanced Care As Usual; Safety Plan; Safety Plan
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: suicide; suicidal ideation; ambivalence; suicide ambivalence; reasons for living; reasons for dying; military; veteran; clinical trial; cognitive behavioral therapy; psychotherapy; crisis; Treatment As Usual (TAU); Crisis Response Plan (CRP); Enhanced Crisis Response Plan (E-CRP)