Suicide and attempted suicide are major public health issues in the U.S., accounting for almost 45,000 deaths in 2016, and over 1 million attempts each year. There is an urgent need for interventions based on evidence- based principles that decrease suicidal behavior and are feasible to deliver to large numbers of patients at times when their risk for suicide is high. In this treatment development project, we propose to develop and test a narrative-based video intervention for people with suicidal behavior or plan being discharged from psychiatric hospitalization. In response to the need for treatment over this transition, we previously developed a 6-month, in-person and telephone, clinician-delivered, psychosocial intervention called Coping Long Term with Active Suicide Program (CLASP) for patients being discharged from psychiatric hospitalization. CLASP targets key risk factors associated with suicidal behavior in order to reduce subsequent risk. In this project, we propose to develop a new intervention, called LifePlans, based on the CLASP model but using an easily disseminable video-based format in which real patients discuss their history of suicidal behavior and coping strategies. Based on previous research, we believe that having people with lived experience tell their own stories has the potential to be engaging and to catalyze behavior change. LifePlans will consist of 5, 30-min episodes that highlight patients? experiences consistent with the CLASP model: 1) developing a personalized ?Life Plan? to stay safe and restrict means, 2) clarifying valued life domains and related goals to improve hopefulness, 3) using problem solving to cope with illness, 4) improving communication with family/friends to increase social support, and 5) adhering to outpatient treatments. This study will have 3 phases. In phase 1, we will interview patients with a history of psychiatric hospitalization for suicidal behavior about their life experiences and coping history. We will invite a subset back to be interviewed on camera for a series of documentary-style videos that will form the basis of LifePlans. After the filming of additional clinician-related content and with feedback from a Patient and Family Advisory Council, we will create 5, 30-min episodes of LifePlans and accompanying patient workbook that illustrate key CLASP principles using narrative methods. We will then conduct an open trial (n=10; phase 2) and a pilot RCT (n=40; phase 3) to test the feasibility/acceptability of LifePlans for hospitalized patients with a pre-admission suicide plan/attempt. Patients will be assessed at baseline, discharge, 1, and 6 months post-discharge on suicidal behaviors (primary), suicidal ideation, psychiatric symptoms, functioning, rehospitalization rate, and possible mechanisms. We will examine feasibility and acceptability (rate of video viewing, engagement, satisfaction, recruitment/retention). In the RCT, we will examine treatment differences (within relevant confidence intervals) on outcomes (e.g., suicide behaviors), and change on possible mechanisms. Ultimately, this project will provide the data needed to test LifePlans in a full-scale RCT to determine its effectiveness and mechanisms of action for suicide prevention in high-risk patients.
The work proposed is expected to result in the development of a brief, video-based intervention that will utilize innovative narrative communication methods to deliver evidence-based principles for suicide prevention to individuals at high risk for suicidal behavior post-hospital discharge. Such results are expected to have an important positive impact that will move us closer to the long-term goal of dissemination and integration of adjunctive interventions into routine care settings to prevent suicides during the vulnerable time of acute care transitions. The proposed research is aligned with NIMH?s ?Prioritized Research Agenda for Suicide Prevention? Objective 3.C. that prioritizes finding interventions for the highest risk groups in care settings to reduce subsequent suicide risk.