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

Utah System of Higher Education (USHE)

Status: Completed

Conditions: Suicidal Ideation; Suicide

Treatments: Behavioral: Treatment As Usual (TAU); Behavioral: Standard Crisis Response Plan (S-CRP); Behavioral: Enhanced Crisis Response Plan (E-CRP)

Study type: Interventional

Funder types: Other

Identifiers

NCT02042131

R01481

W81XWH-10-2-0181

Details and patient eligibility

About

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.

Full 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.

Enrollment: 97 patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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97 participants in 3 patient groups

Treatment As Usual (TAU)

Active Comparator group

Description:

TAU includes the following intervention components: 1. suicide risk assessment 2. supportive listening 3. provision of professional and crisis contact information 4. referral to mental health treatment and community resources 5. verbal contract for safety

Treatment:

Behavioral: Treatment As Usual (TAU)

Standard Crisis Response Plan (S-CRP)

Experimental group

Description:

CRP includes the following intervention components: 1. suicide risk assessment 2. supportive listening 3. identify personal warning signs 4. identify self-management skills 5. identify social support contacts 6. provision of professional and crisis contact information 7. referral to mental health treatment and community resources

Treatment:

Behavioral: Enhanced Crisis Response Plan (E-CRP)

Behavioral: Standard Crisis Response Plan (S-CRP)

Enhanced Crisis Response Plan (E-CRP)

Experimental group

Description:

The E-CRP includes the following intervention components: 1. suicide risk assessment 2. supportive listening 3. identify personal warning signs 4. identify self-management skills 5. identify reasons for living 6. identify social support contacts 7. provision of professional and crisis contact information 8. referral to mental health treatment and community resources

Treatment:

Behavioral: Enhanced Crisis Response Plan (E-CRP)