Suicide prevention in Department of Veterans Affairs community care network mental health settings

About This Grant

BACKGROUND: Suicide is a chief concern in Veterans, particularly following a mental health stay. The Department of Veterans Affairs (VA) has invested heavily in strategies to prevent suicide in Veterans who are at risk of suicide following a Veterans Health Administration (VHA) mental health stay. These interventions, however, do not reach another high-risk population, namely Veterans who access VA-purchased care in the community (i.e., Community Care). This is particularly concerning because an increasing number of Veterans are using VA-purchased care. While Veterans are at high risk of suicide following a Community Care mental health stay, there is little knowledge about effective strategies to mitigate suicide risk in this population. A promising suicide prevention strategy, called the VA Brief Intervention and Contact Program (BIC), has been developed. VA BIC is designed to meet the unique needs of Veterans. Pilot studies of VA BIC in VHA settings have suggested that VA BIC may address key factors related to suicide risk during care transitions including social connectedness and treatment engagement. Based on these promising results and given the critical gaps in suicide prevention care in Veterans who are psychiatrically hospitalized in Community Care settings, it is essential to determine whether VA BIC can reduce suicide risk in this high-risk population. OBJECTIVES: The long-term goal is to design, study, and improve interventions to prevent death by suicide in Veterans. The overall objective of this proposed clinical trial is to determine whether the VA BIC intervention is an effective strategy to reduce suicide risk in Veterans who are admitted to Community Care mental health units. The short-term goal is to test whether the VA BIC intervention can decrease suicidal ideation after a Community Care mental health stay and increase [engagement in mental health care and social connectedness.] The central hypothesis is that VA BIC will [decrease suicidal ideation after discharge] as compared to treatment as usual (TAU). It is hypothesized that VA BIC will [increase engagement in mental health care and social connectedness after discharge] as compared to TAU. The expected outcome of the trial is to ascertain the efficacy of VA BIC in decreasing suicidal ideation and [increasing engagement in mental health care and social connectedness] following a Community Care mental health stay. The trial will inform the design of a future Cooperative Studies Program (CSP) multi-site trial that is powered to test the effect of VA BIC on suicide attempts in Veterans with a psychiatric hospitalization in a Community Care facility. METHODS: A randomized controlled trial of VA BIC will be carried out in Veterans who are psychiatrically hospitalized at Community Care hospitals located in [Northern] New England. Eligible Veterans will be recruited over a three-year timeframe and will be randomized to VA BIC plus TAU, or TAU alone. Participants will be followed for a total of [nine] months. Outcomes will be gathered at baseline and at [3, 6, and 9] months [post baseline.] [A generalized linear mixed model (GLMM)] will be used to determine whether VA BIC results in a significant decrease] in suicidal ideation. A GLMM will [also] be used to learn whether VA BIC results in a significant [increase] in [engagement in mental health care and social connectedness]. An exploratory analysis will examine the effect of VA BIC on suicide attempts. IMPACT: Little is known about effective strategies to prevent suicide in Veterans who are treated in Community Care settings. This proposal will address this concerning knowledge gap by testing a highly promising suicide prevention strategy in Veterans who are psychiatrically hospitalized in Community Care hospitals. The results of the trial will not only determine the impact of VA BIC on suicide risk in this population but also lead to a future CSP trial that is powered to detect the effect of VA BIC on suicide attempts. In the end, the proposal trial will enable the VA to identify a highly effective intervention to prevent suicide in a vulnerable Veteran population that may have little or no interaction with VA providers during a chief period of risk.