Suicide Prevention in Rural Veterans During High-risk Care Transition Scenarios

Overview

In the United States (U.S.), suicide is a major public health concern. U.S. Veterans who live in rural areas may be at even higher risk for suicide than their urban counterparts. Available evidence indicates that suicide risk in rural U.S. Veterans is most concentrated during high-risk care transition scenarios such as discharge from an emergency room. There is limited knowledge about effective interventions to address suicide risk. There is a critical need to develop targeted interventions that address suicide risk during high-risk care transition periods. To be effective, these interventions should address key contributors to suicide risk such as reduced engagement in treatment. This clinical trial evaluates the effect of a suicide prevention intervention to support treatment engagement during high risk transition periods such as discharge from an emergency room.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Single (Outcomes Assessor)
  • Study Primary Completion Date: September 2022

Detailed Description

In the United States (U.S.), death by suicide is a notable public health concern and a particular problem in the U.S. Veteran population. Furthermore, U.S. Veterans who live in rural areas may be at even greater risk for suicide than their urban counterparts. These risks may be concentrated during times of transition in their treatment such as after emergency room discharge. Multiple interventions have been developed to target suicide risk during periods of transition but there is limited evidence regarding their efficacy in preventing suicide. Furthermore, a key contributor to suicide risk may include limited or no engagement in care. Therefore, developing interventions to support engagement in treatment may be effective ways to help mitigate suicide risk and promote participation in care. This clinical trial studies an intervention that is designed to help support treatment engagement during periods of high risk in Veterans who live in rural areas. The trial will recruit Veterans from various treatment settings such as the emergency room and the residential drug treatment programs and follow them for a period of three months. The trial evaluates not only the effect of the intervention on suicidal behavior but also measures of engagement.

Interventions

  • Behavioral: Suicide Prevention Program
    • Structured care management to improve adherence to discharge planning.

Arms, Groups and Cohorts

  • Experimental: Suicide Prevention Program
  • No Intervention: Usual Care

Clinical Trial Outcome Measures

Primary Measures

  • The Beck Scale for Suicidal Ideation (BSSI)
    • Time Frame: Change from Baseline BSSI at 1 months
    • The BSSI ranges from 0-38. While there is no established BSSI cutoff score to classify suicide risk, here is evidence that higher scores on the BSSI correspond to more severe suicidal ideation and that an improvement of five points or more on the total BSSI scores may be clinically relevant.
  • The Beck Scale for Suicidal Ideation (BSSI)
    • Time Frame: Change from Baseline BSSI at 3 months
    • The BSSI ranges from 0-38. While there is no established BSSI cutoff score to classify suicide risk, here is evidence that higher scores on the BSSI correspond to more severe suicidal ideation and that an improvement of five points or more on the total BSSI scores may be clinically relevant.

Secondary Measures

  • The Beck Scale for Hopelessness (BSH)
    • Time Frame: Change from Baseline BSH at 1 months
    • The BSH ranges from 0-20 with higher scores associated with increased hopelessness.
  • The Beck Scale for Hopelessness (BSH)
    • Time Frame: Change from Baseline BSH at 3 months
    • The BSH ranges from 0-20 with higher scores associated with increased hopelessness.
  • The Partners in Health Scale (PIH)
    • Time Frame: Change from Baseline PIH at 1 months
    • The PIH is used to measure patient self-management of chronic conditions. It is a 12-item instrument, each question measured on a Likert scale of 0-8. Higher scores indicate better self-management.
  • The Partners in Health Scale (PIH)
    • Time Frame: Change from Baseline PIH at 3 months
    • The PIH is used to measure patient self-management of chronic conditions. It is a 12-item instrument, each question measured on a Likert scale of 0-8. Higher scores indicate better self-management.
  • Interpersonal Needs Questionnaire 15 (INQ-15)
    • Time Frame: Change from Baseline INQ-15 at 1 months
    • The INQ-15 is a 15-item self-report scale that measures thwarted belongingness (9 items) and perceived burdensomeness (6 items). Each item is measured on a 7-point Likert scale, with higher scores suggesting lower perceived connectedness.
  • Interpersonal Needs Questionnaire 15 (INQ-15)
    • Time Frame: Change from Baseline INQ-15 at 3 months
    • The INQ-15 is a 15-item self-report scale that measures thwarted belongingness (9 items) and perceived burdensomeness (6 items). Each item is measured on a 7-point Likert scale, with higher scores suggesting lower perceived connectedness.
  • Columbia Suicide Severity Rating Scale (CSSR-S)
    • Time Frame: Number of events according to the CSSR-S at 1 months
    • The C-SSRS is a valid and reliable scale that includes a seven-item subscale that asks patients to self-report on actual attempts, interrupted attempts, aborted attempts, and preparatory acts or behaviors.
  • Columbia Suicide Severity Rating Scale (CSSR-S)
    • Time Frame: Number of events according to the CSSR-S at 3 months
    • The C-SSRS is a valid and reliable scale that includes a seven-item subscale that asks patients to self-report on actual attempts, interrupted attempts, aborted attempts, and preparatory acts or behaviors.

Participating in This Clinical Trial

Inclusion Criteria

  • Per the unit psychiatrist, hospitalization was due to concerns about acute risk for self-harm including suicidal ideation, suicide attempt, and/or admitting provider deemed the patient was at imminent risk for self-harm
  • Be a Veteran eligible to receive VA services
  • Be able to speak English

Exclusion Criteria

  • Unable to provide informed consent
  • Potentially vulnerable populations including prisoners, institutionalized patients, or involuntarily committed patients

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • White River Junction Veterans Affairs Medical Center
  • Collaborator
    • US Department of Veterans Affairs
  • Provider of Information About this Clinical Study
    • Principal Investigator: Brian Shiner, Staff Psychiatrist – White River Junction Veterans Affairs Medical Center
  • Overall Official(s)
    • Brian R Shiner, MD, MPH, Principal Investigator, White River Junction Veterans Affairs Medical Center
  • Overall Contact(s)
    • Sarah L Cornelius, BS, 802-295-9363, sarah.cornelius@va.gov

Clinical trials entries are delivered from the US National Institutes of Health and are not reviewed separately by this site. Please see the identifier information above for retrieving further details from the government database.

At TrialBulletin.com, we keep tabs on over 200,000 clinical trials in the US and abroad, using medical data supplied directly by the US National Institutes of Health. Please see the About and Contact page for details.