Brief Interventions for Short-Term Suicide Risk Reduction in Military Populations

Study Overview
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Brief Summary
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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: 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). 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). 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
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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.

Official Title
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Brief Interventions for Short-Term Suicide Risk Reduction in Military Populations

Conditions
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Suicide, Suicidal Ideation

Intervention / Treatment
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* Behavioral: Treatment As Usual (TAU)
* Behavioral: Standard Crisis Response Plan (S-CRP)
* Behavioral: Enhanced Crisis Response Plan (E-CRP)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Active duty 18 years of age or older Reporting current suicidal ideation with intent to die, or a suicide attempt within the past two weeks Able to speak and understand the English language Able to complete the informed consent process Exclusion Criteria: Severe psychiatric or medical conditions that preclude the ability to provide informed consent or participation in outpatient treatment

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Treatment As Usual (TAU)<br>TAU includes the following intervention components: suicide risk assessment supportive listening provision of professional and crisis contact information referral to mental health treatment and community resources verbal contract for safety | Behavioral: Treatment As Usual (TAU)<br> <br> * Other names: Enhanced Care As Usual;|
| Experimental: Standard Crisis Response Plan (S-CRP)<br>CRP includes the following intervention components: suicide risk assessment supportive listening identify personal warning signs identify self-management skills identify social support contacts provision of professional and crisis contact information referral to mental health treatment and community resources | Behavioral: Standard Crisis Response Plan (S-CRP)<br> <br> * Other names: Safety Plan;Behavioral: Enhanced Crisis Response Plan (E-CRP)<br> <br> * Other names: Safety Plan;|
| Experimental: Enhanced Crisis Response Plan (E-CRP)<br>The E-CRP includes the following intervention components: suicide risk assessment supportive listening identify personal warning signs identify self-management skills identify reasons for living identify social support contacts provision of professional and crisis contact information referral to mental health treatment and community resources | Behavioral: Enhanced Crisis Response Plan (E-CRP)<br> <br> * Other names: Safety Plan;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Estimated Proportion of Participants With Suicide Attempt | Suicide attempts were assessed using the Suicide Attempt Self Injury Interview (SASII; Linehan et al., 2006). The SASII is a valid and reliable clinician-administered interview for categorizing suicide-related and self-injurious behaviors. Suicide attempt was defined as behavior that is self-directed and deliberately results in injury or the potential for injury to oneself for which there is evidence, whether implicit or explicit, of suicidal intent | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Beck Scale for Suicide Ideation (BSSI) | The BSSI is used to evaluate the intensity of the patient's specific attitudes, behaviors, and plans to make a suicide attempt. BSSI total score was used as the outcome measure. Total scores range from 0 to 38, with higher scores indicating more severe suicide ideation. | 1 month, 3 months, and 6 months | 
| Inpatient Psychiatric Hospitalization Days | Mean number of days of inpatient psychiatric hospitalization | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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suicide, Treatment As Usual (TAU), suicidal ideation, ambivalence, suicide ambivalence, reasons for living, reasons for dying, military, veteran, clinical trial, cognitive behavioral therapy, psychotherapy, crisis, Crisis Response Plan (CRP), Enhanced Crisis Response Plan (E-CRP)