August 2017

In this Issue: Suicide Prevention
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Improving Care for Veterans Coping Long-Term with Suicide

Feature Article

Suicide is one of the leading causes of death for military personnel, and for the first time in recorded history, the rates of military suicides exceed civilian rates. Consequently, finding novel, efficacious, and acceptable methods to reduce suicide behaviors is of great military health relevance. The Veteran's Coping Long Term with Active Suicide Program (CLASP-VA) is a unique suicide reduction program that combines individual therapy, case management, and family interventions with the implementation of both individual and telephone-based therapeutic strategies adapted from innovative newer cognitive-behavioral and family approaches. In addition, it is one of the few programs that directly targets high-risk patients at the time of hospital discharge–and also is one of the few empirically-developed and promising interventions (e.g., strong pilot data) for individuals hospitalized for suicide behavior.

The primary objective of this ongoing HSR&D study is to test the efficacy of CLASP-VA in a sample of Veterans at risk for suicide behavior. CLASP-VA is a six-month, telephone-based, adjunctive program designed for Veterans at risk for suicide. Investigators are recruiting Veteran inpatients from the Providence VAMC. Participants are randomly assigned to either CLASP-VA or an enhanced monitoring control condition. The intervention combines aspects of problem-solving therapy, case management, family support, and assessment.

In this study, CLASP will be compared to an enhanced monitoring control condition. Study participants will be assessed on all outcomes at baseline, 3-, 6-, 9-, and 12-month follow-up. Primary outcome is suicide attempts. Secondary outcomes are re-hospitalization due to suicide risk and suicidal ideation. Tertiary outcomes include treatment engagement, psychiatric symptoms, and psychosocial functioning. To date, 168 Veterans have been assessed and more than 100 Veterans have been randomized to either the CLASP intervention or the enhanced monitoring condition. Recruitment is still ongoing and data collection is in progress. Qualitative feedback for CLASP has been overwhelmingly positive. Recruitment will continue through August 2017, and then the study will move into the data analysis phase.

Impact: This study could have a significant impact on the care of at-risk Veterans by decreasing the rate of subsequent suicidal behavior and re-hospitalization, and by enhancing and standardizing treatment of suicide within VA. Moreover, because CLASP is designed to be administered by master's level clinicians, it is a program that could be scaled more readily than those requiring psychologists or psychiatrists.

Principal Investigator: Jennifer Primack, PhD, is part of HSR&D's Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans in Providence, RI.

Improving Care for Veterans Coping Long-Term with Suicide project abstract.