Motivational Interviewing to Address Suicidal Ideation for Veterans at High Risk for Suicide (MI-SI)

VA Office of Research and Development

Status: Enrolling

Conditions: Suicide, Attempted; Suicidal Ideation

Treatments: Other: Enhanced usual care (EUC); Behavioral: Motivational Interviewing to Address Suicidal Ideation- Revised (MI-SI-R)

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT05256940

I01CX002359 (Other Grant/Funding Number)

MHBC-001-21S

Details and patient eligibility

About

The purpose of this project is to conduct a randomized control trial with 470 Veterans to examine the impact of a revised version of Motivational Interviewing to Address Suicidal Ideation (MI-SI-R) on risk for suicide attempts and suicidal ideation when compared to high quality usual care.

Full description

Research suggests that treatments to reduce suicidal behavior may need to focus on both the motivation to live and the motivation to die to obtain optimal effects. The PI developed a revised version of Motivational Interviewing to Address Suicidal Ideation (MI-SI-R) to help Veterans resolve ambivalence about living by increasing the motivation to live, that consists of three sessions delivered in-person, virtually, or by telephone. Enhanced usual care (EUC) for high-risk Veterans includes safety plans administered or reviewed by research therapists, care coordination, and access to a 24-hour crisis hotline. In a preliminary randomized controlled trial (RCT) in psychiatrically hospitalized Veterans, MI-SI-R plus EUC was associated with 50% fewer suicide attempts and 41% lower likelihood of suicidal ideation compared to EUC alone. The investigators are proposing an RCT comparing MI-SI-R plus EUC (MI-SI-R+EUC) to EUC alone in a sample of 470 high-risk Veterans with recent suicidal crises from three VHA Medical Centers, with "high-risk" defined as a suicide attempt within a month or suicidal ideation > 5 on the Beck Scale for Suicidal Ideation. Half (n = 235) will be randomized to MI-SI-R+EUC (three sessions in-person, via Video Connect, or telephone) and the remaining participants (n = 235) will receive EUC alone. All participants will be asked to complete telephone follow-up assessments at 1, 3, 6, and 12-months after randomization. This will allow the investigators to determine the efficacy of MI-SI-R+EUC in reducing risk for suicide attempts (Aim 1) and reducing overall suicidal ideation (Aim 2) when compared to EUC alone.

Enrollment: 470 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Veteran status,
• admitted to an inpatient unit, referred by a suicide prevention coordinator, or identified as high-risk via data extraction,
• age 18 and over,
• English speaking and reading, and
• ability to understand the study and provide informed consent,
• high-risk status confirmed by suicide attempt within a month on the Columbia- Suicide Severity Rating Scale or a score > 5 on the Scale for Suicidal Ideation

Exclusion criteria

• current psychosis,
• active mania,
• dementia,
• impaired decision making capacity, and
• institutionalization due to hospitalization in a non-VA facility, jail, or prison.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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470 participants in 2 patient groups

Motivational Interviewing to Address Suicidal Ideation- Revised (MI-SI-R)

Experimental group

Description:

Motivational Interviewing to Address Suicidal Ideation (MI-SI-R) was developed to help Veterans resolve ambivalence about living by increasing the motivation to live, and is delivered in three sessions in person, virtually, or by telephone.

Treatment:

Behavioral: Motivational Interviewing to Address Suicidal Ideation- Revised (MI-SI-R)

Other: Enhanced usual care (EUC)

Enhanced usual care (EUC)

Active Comparator group

Description:

Enhanced usual care (EUC) includes safety plans administered or reviewed by research therapists, care coordination, and access to a 24-hour crisis hotline.

Treatment:

Other: Enhanced usual care (EUC)