Suicide Clinical Trial
Official title:
Brief Interventions for Short-Term Suicide Risk Reduction in Military Populations
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.
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.
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