Suicide
Conditions
Brief summary
The goal of this research plan is to test the effectiveness of a brief, cognitive behavioral (CB) intervention to promote behavioral health treatment engagement among at-risk Veterans who call the Crisis Line but are resistant to behavioral health services.
Detailed description
The goal of this research plan is to test the effectiveness of a brief, cognitive behavioral (CB) intervention to promote behavioral health treatment engagement among at-risk Veterans who call the Crisis Line but are resistant to behavioral health services. This randomized controlled trial will recruit 80 Veterans who report current suicidal ideation at the time of the Crisis Line call and are resistant to seeking behavioral health treatment. Half of the participants will receive the brief, individualized CB intervention and half will receive standardized procedures from VA's Crisis Line (i.e., usual care). The effectiveness of the intervention will be tested on 1) attitudes toward behavioral health treatment rates, and 2) initiation of and adherence to treatment (assessed by the number of sessions attended). The investigators will also assess the impact of the intervention on suicidal ideation (SI) and explore the impact on the most common symptoms observed in Veteran suicide decedents (e.g., depression).
Interventions
BEHAVIORALCB Intervention
The Cognitive Behavioral (CB) intervention is a brief, manualized, tailored one-on-one single session lasting 45-60 minutes and administered by phone. An individual format was chosen to reduce the potential discomfort of stigma of individual concerns in the presence of others. The intervention targets a change in the beliefs that influence whether or not someone enters mental health or substance use treatment. During the session, participants will be given a brief introduction to CBT and informed that CBT is based on the theory that cognitions (i.e., thoughts/beliefs), feelings and behaviors all interact with each other;101, 102 therefore, thoughts about certain situations or things influence behavior. Since thoughts are modifiable, changing thoughts about situations may change behavior.
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Inclusion criteria for the study are as follows: * individuals 18 and older who call the Veteran Crisis Line * have a phone number where they can be reached, be it a land line or a cell phone * deemed by the Crisis Line responder to be at risk for suicide, but not imminent risk * refuse a referral to the SPC or to a behavioral health treatment provider during the call * report current suicidal ideation (SI) during the call based on administration of a standard item * have not been in behavioral health treatment in the past. Presence of SI will be subsequently confirmed by the research assistant using the Columbia Suicide Severity Rating Scale, a validated instrument.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Treatment Engagement (Number of Participants Entering Treatment) | 30 days after baseline | The investigators will be asking about service utilization since baseline interview. Zero = no mental health treatment and 1 = received mental health treatment. |
Countries
United States
Participant flow
Recruitment details
The trial implemented the intervention at the VA's National Crisis Line during a period of dynamic change at the Crisis Line including turnover of top leadership and major changes in procedures and personnel. Our bottom line recruitment numbers were low.
Participants by arm
| Arm | Count |
|---|---|
| Usual Care No intervention. | 10 |
| CB Intervention Cognitive Behavioral one-on-one single session administered by phone
CB Intervention: The Cognitive Behavioral (CB) intervention is a brief, manualized, tailored one-on-one single session lasting 45-60 minutes and administered by phone. An individual format was chosen to reduce the potential discomfort of stigma of individual concerns in the presence of others. The intervention targets a change in the beliefs that influence whether or not someone enters mental health or substance use treatment. During the session, participants will be given a brief introduction to CBT and informed that CBT is based on the theory that cognitions (i.e., thoughts/beliefs), feelings and behaviors all interact with each other;101, 102 therefore, thoughts about certain situations or things influence behavior. Since thoughts are modifiable, changing thoughts about situations may change behavior. | 9 |
| Total | 19 |
Baseline characteristics
| Characteristic | CB Intervention | Usual Care | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 9 Participants | 10 Participants | 19 Participants |
| Age, Continuous | 39.8 years STANDARD_DEVIATION 14.6 | 44.6 years STANDARD_DEVIATION 17.9 | 41.2 years STANDARD_DEVIATION 15.9 |
| Region of Enrollment United States | 9 participants | 10 participants | 19 participants |
| Sex: Female, Male Female | 1 Participants | 2 Participants | 3 Participants |
| Sex: Female, Male Male | 8 Participants | 8 Participants | 16 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 10 | 0 / 9 |
| other Total, other adverse events | 0 / 10 | 0 / 9 |
| serious Total, serious adverse events | 0 / 10 | 0 / 9 |
Outcome results
Primary
Change in Treatment Engagement (Number of Participants Entering Treatment)
The investigators will be asking about service utilization since baseline interview. Zero = no mental health treatment and 1 = received mental health treatment.
Time frame: 30 days after baseline
Population: Only 7 of the 10 control participants and 4 of the 9 intervention participants completed follow-up assessments.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Usual Care | Change in Treatment Engagement (Number of Participants Entering Treatment) | 4 Participants |
| CB Intervention | Change in Treatment Engagement (Number of Participants Entering Treatment) | 4 Participants |