Clinical trial NCT02042131: Brief Interventions for Short-Term Suicide Risk Reduction in Military Populations
Official title: Brief Interventions for Short-Term Suicide Risk Reduction in Military Populations
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Suicide
Suicidal Ideation
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)
Lead sponsor: University of Utah
Sponsor class: OTHER
Collaborators: name: The University of Texas Health Science Center at San Antonio
First posted: 2014-01-22
Enrollment: 97
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief 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.

Eligibility criteria: 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

Primary outcomes:
measure: Estimated Proportion of Participants With Suicide Attempt
timeFrame: 6 months
Secondary outcomes:
measure: Beck Scale for Suicide Ideation (BSSI)
timeFrame: 1 month, 3 months, and 6 months
measure: Inpatient Psychiatric Hospitalization Days
timeFrame: 6 months
Other outcomes:
measure: Number of Participants Who Were Admitted for Psychiatric Hospitalization Immediately Post-intervention by a Blinded Clinician
timeFrame: Immediately post-intervention
Locations:
city: Colorado Springs
country: United States
facility: Fort Carson
state: Colorado
Study officials:
affiliation: National Center for Veterans Studies & The University of Utah
name: Craig J Bryan, PsyD, ABPP
role: PRINCIPAL_INVESTIGATOR
affiliation: National Center for Veterans Studies & The University of Utah
name: Tracy A Clemans, PsyD
role: STUDY_DIRECTOR
References:
citation: Bryan CJ, Mintz J, Clemans TA, Burch TS, Leeson B, Williams S, Rudd MD. Effect of Crisis Response Planning on Patient Mood and Clinician Decision Making: A Clinical Trial With Suicidal U.S. Soldiers. Psychiatr Serv. 2018 Jan 1;69(1):108-111. doi: 10.1176/appi.ps.201700157. Epub 2017 Oct 2.
citation: Lowder EM, Rade CB, Desmarais SL. Effectiveness of Mental Health Courts in Reducing Recidivism: A Meta-Analysis. Psychiatr Serv. 2018 Jan 1;69(1):15-22. doi: 10.1176/appi.ps.201700107. Epub 2017 Aug 15.