SAFER: A Brief Intervention Involving Family Members in Suicide Safety Planning
Condition: Suicide
MeSH terms: Suicide
Study type: Interventional

Summary: 
      The management of suicide risk is a pressing national public health issue especially among
      Veterans, and there exist no guidelines of how best to involve family members in this effort.
      This proposal will integrate family and couples communication skills training with suicide
      safety planning. The goal is for the sharing of Veteran suicide safety plans with family
      members and the construction of a parallel family member safety plan, in efforts to mobilize
      and support family involvement.
    

Detailed description: 
      Psychological models of suicidality emphasize the role of social factors in the development
      and intensification of suicidal thoughts and behavior, including feeling like a burden on
      family and friends, feelings of isolation and not belonging, and perceptions of diminished
      support from one's family and social network. Despite the critical role of family factors in
      protecting against suicidality, families lack education on how their behavior can help avert
      or unwittingly aggravate suicidal thoughts/ behavior. Families worry about their relative but
      feel uncertain of how to help and need professional guidance. Family worries about
      suicidality are associated with compromised family physical and mental health and
      consequently, diminished ability to offer needed support. Because suicide safety plans rely
      on mobilizing support in times of crisis, families need to be equipped to provide needed
      support.

      Family recommendations from the VA Behavioral Health Autopsy Program (BHAP) Annual Report
      6/30/15 based on interviews with 114 family members highlighted the importance of:

        1. educating families about suicide warning signs:

        2. improving communication between the veteran and family member

        3. involving the family in the veterans' treatment to enhance support and trust

        4. providing families with coaching on how to assist their loved one to seek help.

      Management of suicidal behavior is covered in comprehensive family psychoeducation programs,
      but there is an urgent need for a brief family-based intervention specifically focused on
      suicide prevention that can be used in conjunction with the currently mandated SSP and as a
      part of routine care.

      Despite the enrichment of VA suicide prevention services and implementation of the national
      suicide hotline, Veteran suicide completions have risen to 22 per day and suicide attempts
      numbered over 15,000 in 2012. These data underscore the urgency of developing additional
      interventions targeting suicidal Veterans. One potential avenue to further suicide treatment
      and rehabilitation efforts is to develop strategies that maximize family support, however
      almost no family interventions exist for suicidal Veterans. The construction of a Suicide
      Safety Plan (SSP); a "best practice," is mandated throughout the VA system, and a vital
      component of the VA's coordinated effort at suicide prevention and recovery. The pilot data
      on patterns of SSP use in suicidal Veterans highlighted the importance of sharing the plan
      with family or close friends. However, respondents also noted significant obstacles in their
      ability to reach out to others when in distress. To the knowledge of Investigators, there are
      currently no recommended guidelines or mechanisms for involving family in safety planning,
      despite its inclusion as a step of the plan. "Safe Actions for Families to Encourage
      Recovery" (SAFER) a novel suicide safety planning family intervention has been designed to
      fill this critical gap and provide a mechanism to communicate about safety planning. SAFER, a
      4-session, family intervention, combines education about suicide and suicide safety planning
      with communication skills training from evidence-based practices. The aim is to facilitate
      communication about suicide safety planning and to develop both a Veteran and family member
      safety plan.

      Data from this project will test the intervention's feasibility, acceptability and
      preliminary efficacy in a Stage II small-scale randomized clinical trial in 39 moderate
      suicide risk Veterans and their supporting partners. The comparison condition will be safety
      planning without supporting partner involvement plus weekly check-in phone calls. Primary
      Veteran outcomes include reducing suicidal ideation/behavior. Secondary Veteran outcomes
      include reducing suicidal cognitions (hopelessness, perceived burdensomeness, thwarted
      belongingness) and depression and improving subjective social support. Supporting Partner
      primary outcomes include reducing caregiver burden and secondary outcomes of improving
      suicide-related coping and family empowerment.
    

Intervention name(s): Safe Actions for Families to Encourage Recovery; Individual Safety Planning Intervention
Intervention type(s): Behavioral; Behavioral
Intervention description(s): A novel, 5-session intervention to enhance currently mandated VA suicide safety planning by involving family members to support its implementation. Incorporation of education about suicide risk factors and teaching communication skills of active listening and making a positive request will supply Veterans and family members with the knowledge and tools needed to 1) identify potential warning signs, and 2) discuss Veteran ideation or family concerns with assurance that such requests will be listened to with validation and support, creating an ally for the suicidal Veteran in his struggle. As discussed above, research has demonstrated compellingly that suicidal desire is motivated by two interpersonal factors; perceived burdensomeness and thwarted belongingness. SAFER aims to increase family support for the Veteran to directly mitigate Veteran loneliness and sense of being a burden to others.; The comparison condition will be an assessment-only enhanced treatment-as-usual intervention called the Individual Safety Planning Intervention (I-SPI).
Other intervention name(s): SAFER; I-SPI
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants are assigned to one of two groups in parallel for the duration of the study.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Family Caregivers; Spouse Caregivers; Veterans; Suicide; Clinical Trial; Military Families; Military Psychology