Randomized Controlled Trial of a Single-session Mechanism-focused Intervention for Suicidal Thoughts and Behaviors

Study Overview
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Brief Summary
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Across multiple models of suicide risk, hopelessness and perceptions of social relatedness (i.e., lack of social connection/thwarted belongingness, perceived burdensomeness) have emerged as candidate mechanisms that maintain STBs. Although these mechanisms have garnered strong empirical support in predicting STBs, there has been virtually no integration with interventions aimed for individuals at acute risk for suicide. Thus, the overarching goal of the present proposal is to evaluate a mechanism-focused intervention that explicitly targets two core mechanisms implicated in the maintenance of STBs: hopelessness and negative perceptions of social relatedness. Given that the period immediately following hospital discharge presents the highest risk for suicide attempts and up to 70% of patients admitted for a suicide attempt do not attend their first outpatient appointment, the intervention will be evaluated on an inpatient unit. Additionally, most of the extant interventions for STBs are administered across multiple sessions (i.e., 4 sessions and up to one year); however treatments of this length are unlikely to be feasible in acute care settings. Fortunately, very brief suicide prevention interventions, are effective in reducing future suicide attempts and increasing the likelihood of attending follow-up treatments. Additionally, single-session interventions (not suicide specific) have been shown to reduce hopelessness immediately and at a one-month follow-up. The present study is an RCT comparing a novel Single Session Mechanism Focused Intervention (SSMFI) for STBs to treatment-as-usual (TAU) on a psychiatric inpatient unit for patients admitted for suicidal ideation or attempt. The engagement of the putative processes (hopelessness and negative perceptions of social relatedness) that maintain STBs will be assessed, along with the feasibility and acceptability of SSMFI for STBs on an inpatient psychiatric unit.

Official Title
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Testing a Single-session Mechanism-focused Intervention for Suicidal Thoughts and Behaviors

Conditions
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Suicidal Ideation

Intervention / Treatment
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* Behavioral: Single-Session Mechanism-Focused Intervention (SSMFI)
* Behavioral: Distress Tolerance Skills Review


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: admitted for care to the Adult Inpatient Unit at Good Samaritan Hospital endorse suicidal ideation and/or a recent suicide attempt (i.e., a potentially self-injurious act committed with at least some wish to die) upon intake to the unit 18 years of age; (4) English speaking able to provide two methods for follow-up contact (i.e., phone number, email address) in order to complete study follow-up assessment. Exclusion Criteria: current manic episode acutely psychotic actively detoxicating from substances the inability to comprehend the intervention

Ages Eligible for Study
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Minimum Age: 18 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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Single-Session Mechanism Focused Intervention (SSMFI)<br> | Behavioral: Single-Session Mechanism-Focused Intervention (SSMFI)<br>* A brief intervention for patients hospitalized for suicide risk that directly targets hopelessness and perceptions of social relatedness.<br>|
| Active Comparator: Treatment as Usual<br> | Behavioral: Distress Tolerance Skills Review<br>* Treatment as usual at the inpatient setting for this study.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Beck Hopelessness Scale | Hopelessness will be measured with the Beck Hopelessness Scale. Scores range from 0-20 and higher scores indicate greater levels of hopelessness. | pre-intervention, 1 week after the intervention is completed, 1 month after the intervention is completed | 
| Change in Interpersonal Needs Questionnaire | Perceptions of social connectedness will be assessed with the Interpersonal Needs Questionnaire. Scores range from 0 to 107 with higher scores indicating less connection with others. | pre-intervention, 1 week after the intervention is completed, 1 month after the intervention is completed | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Columbia Suicide Severity Rating Scale | The self-report version of the Columbia Suicide Severity Rating Scale will be used to assess the presence of suicidal behaviors thoughts and behaviors. Participants are asked to respond Yes/No to 6 items that refer to various suicide related phenomena (thoughts, planning, intent, and behaviors). There is no total score for this measure. | pre-intervention, 1 week after the intervention is completed, 1 month after the intervention is completed | 
| Change in Adult Suicidal Ideation Questionnaire | Intensity of suicidal ideation will be measured with the Adult Suicidal Ideation Questionnaire. Scores range from 0-150 and higher scores indicate greater intensity of suicidal ideation. | pre-intervention, 1 week after the intervention is completed, 1 month after the intervention is completed |