Suicide Prevention
Conditions
Keywords
Loneliness, perceived social support
Brief summary
Given their elevated risk for suicide and barriers to engaging in VHA healthcare, violence-exposed women Veterans represent a specialized population for which expansions to current VHA programming are needed. This pilot study is to assess the feasibility, acceptability, and preliminary efficacy of the Growth, Resilience, Insight, and Togetherness (GRIT), a therapeutic retreat program developed with and for Veteran women, to improve social functioning as a potential upstream suicide prevention strategy in comparison to a self-guided program. If found acceptable and feasible, data gathered will inform subsequent program development and identify avenues for further research on use of retreats grounded in Whole Health principles for additional subpopulations of women Veterans and/or other high-risk populations that may benefit.
Detailed description
Women Veterans are exposed to interpersonal violence at high rates throughout their lifespans which may escalate risk for psychosocial impairment and suicidal behavior. Facets of social functioning such as connectedness and social support can mitigate suicide risk. Given their risk for suicide and barriers to engaging in Veterans Administration (VHA) healthcare, violence-exposed women Veterans represent a specialized population for which expansion of VHA programming to include opportunities for socialization and community building as a key component of holistic health are needed. Coinciding with a congressional mandate for women-only retreat-based rehabilitation following military service, retreats are increasingly offered by community organizations. Retreats are associated with significant improvements in mental health and quality of life; however, no research to date has examined retreat programming as an upstream suicide prevention strategy for a high priority, high risk population of Veterans. The primary aim of this multi-site, two-year, pilot study is to evaluate the feasibility, acceptability, and preliminary efficacy of "Growth, Resilience, Insight, and Togetherness" (GRIT), a retreat-based intervention designed for women Veterans who have experienced intimate partner violence (IPV). GRIT is a retreat-based program designed to enhance social functioning for women Veterans as an upstream suicide prevention strategy. Grounded in Whole Health principles, this holistic complementary program offered in a nature-based, tranquil setting was created for, and with input from, women Veterans known to be at heightened suicide risk due to experiences of interpersonal violence. Through participation in group activities, experiential learning, and envisioning and planning for the future post-retreat, GRIT seeks to combat loneliness and isolation while fostering connection to self and others to support longer term recovery from the sequelae of violence exposure(s). Using a selective suicide prevention strategy, 48 women Veterans (N = 48) who have experienced interpersonal violence and endorse difficulties in at least two areas of social functioning will be recruited from two VA medical centers: VA Providence Healthcare system and VA Connecticut healthcare system. Eligible participants will be randomly assigned to the GRIT retreat or Growth, Resilience, and Insight (GRI), a self-guided version of the program that does not include a retreat. Participants will receive the GRIT in cohorts of approximately 12. Retreats will be co-led by pairs of VHA trained facilitators from VA Connecticut. A mixed methods approach will be used to evaluate feasibility and acceptability of GRIT and study procedures. Feasibility metrics will include ease of recruitment, program and study completion, and number of adverse events. Acceptability metrics will include participant ratings of satisfaction, credibility, perceived usefulness, and low burdensomeness of study procedures and GRIT/GRI programs. Preliminary efficacy data will be collected on social functioning and mental health impairment, and suicide risk pre-, post-, and two months following program completion.
Interventions
BEHAVIORALGRIT
3-day retreat conducted in person, in a group setting.
BEHAVIORALGRI
3-day self paced program. Conducted individually with group pre- and post-program sessions.
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Women Veterans will be randomized to either the GRIT retreat-based condition or GRI, a self-guided version of the program that does not include a retreat. Participants will be randomized using a computer-generated block randomization sequence into one of the two conditions, with 24 participants randomized to each group. Random block sizes of 4 and 6 will be used to maintain allocation balance while reducing predictability of assignment. Veteran participants will be assessed at baseline, during the intervention, post-intervention, 2-month follow up using a combination of self-report measures, interview-administered measures, and a semi-structured interview to obtain data on feasibility, acceptability, and preliminary efficacy.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Experienced interpersonal violence as evidenced by endorsement of items 6, 7, 8, 9, or 11 from the Life Events Checklist for DSM-5® 2. Are willing and able to participate in a two overnight, three-day, retreat and complete pre- and post-retreat surveys 3. Are actively engaged in VHA mental healthcare (i.e., have a documented mental health visit with a VA provider within the last 90 days 4. Endorse some difficulties in social functioning as indicated by a score \>2 on at least two items of the social functioning questionnaire 5. Ability to speak, read, and understand spoken English sufficiently well to complete the procedures of the study 6. Have access to a mobile phone or computer device that will enable participation in virtual video sessions
Exclusion criteria
1. Current suicidal thoughts and intent (using the Columbia Suicide Severity Rating Scale; C-SSRS, (i.e., endorses items 1, 2, and 4 or 5) 2. Diagnosis of alcohol or substance use dependence in medical record. In cases where alcohol or substance use is identified as problematic but not reaching the threshold for diagnosis of SUD dependence, additional consultation with mental health providers and chart review by the PI will be used to determine suitability for participation 3. Current psychosis or mania as indicated by electronic health records, or as identified during baseline administration of Quick SCID
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility (study created metrics) | 2 months | Feasibility will be assessed by collecting information on the number of Veterans screened, enrolled, dropout rates, number of GRIT/GRI sessions completed. Determination of feasibility will be made by comparing the obtained metrics to the following metrics: * Recruit and enroll 12 participants per condition per year. * Dropout rate is \< 25% * 75% of participants complete ≥75% each condition sessions |
| Client Satisfaction Questionnaire | 2 months | An 8-item self-report measure assessing participants' satisfaction with services received. Items are rated on a 4-point Likert scale with higher scores indicating greater satisfaction with services. |
| UCLA Loneliness scale | 2 months | A 20-item self-report measure assessing subjective feelings of loneliness and social isolation. Items are rated on 4-point Likert scale ranging from 1 to 4 with higher scores indicated greater loneliness |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Social Functioning Questionnaire | 2 months | The Social Functioning Questionnaire (SFQ) consists of 8 items designed to assess an individual's social functioning across various domains. Each item evaluates key aspects such as interpersonal relationships, work performance, and leisure activities through concise questions. Responses are measured on a 4-point Likert scale ranging from 0 (not at all) to 3 (most of the time), allowing for quantifiable assessment of social engagement and difficulties. |
| Social Connectedness Scale, revised | 2 months | The Social Connectedness Scale - Revised (SCS-R) is a 20-item instrument designed to measure an individual's sense of connectedness and belonging within their social environment. The scale consists of 20 items rated on a 6-point Likert scale, where 1 indicates "strongly disagree" and 6 indicates "strongly agree." This allows for a nuanced understanding of an individual's feelings of connectedness. Scores are summed to yield a total score ranging from 20 to 120. A higher score reflects greater feelings of connectedness, while a lower score may indicate feelings of isolation or disconnection |
| Thwarted belongingness subscale of the Interpersonal Needs Questionnaire | 2 months | This subscale is a self-report measure of perceived social disconnection, loneliness, and unmet need to belong. The subscale consists of 9 items rated on a 7-point Likert scale. Higher scores indicate greater thwarted belongingness. |
Countries
United States
Contacts
CONTACTJennifer M Primack, PhD MA
CONTACTKimberly Marcolivio, MEd CCRP
PRINCIPAL_INVESTIGATORJennifer Marie Primack, PhD MA
Providence VA Medical Center, Providence, RI
Outcome results
None listed