August 2017

In this Issue: Suicide Prevention
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Facilitating Use of the Veterans Crisis Line in Veterans at High Risk for Suicide

Feature Article

The Veterans Crisis Line was developed to provide easily accessible support during high-risk periods to prevent suicidal behaviors among Veterans and VA patients. Observational data provide support for the appeal and utility of suicide crisis lines, however, more definitive efficacy data are lacking. Furthermore, preliminary data indicates that it is likely that the crisis line is being under-utilized by Veterans who could benefit from these services. Consequently, study investigators developed a new intervention: Crisis Line Facilitation (CLF) is a brief, motivational interviewing-based therapy that includes a practice call to the Crisis Line, and is aimed at addressing Veterans' perceived barriers and facilitators of crisis line use during periods of suicidal crisis. This ongoing HSR&D study is evaluating the efficacy of CLF versus Enhanced Usual Care (EUC) in increasing crisis line use and decreasing suicidal behaviors among Veterans with recent inpatient hospitalization for a suicidal crisis.

Investigators will screen approximately 1,042 Veterans hospitalized for a recent suicidal crisis (significant ideation, plan, and/or recent attempt requiring psychiatric hospitalization) at one of two VA inpatient psychiatry units to determine whether they had called the Veterans Crisis Line. A sample of 500 Veterans who had not used the Veterans Crisis Line within the past year will be recruited and randomly assigned to either the intervention (CLF) or enhanced usual care. CLF will occur in a single-session before the Veterans are released from psychiatric hospitalization. All participants will be re-assessed at 3-, 6- and 12-months post-baseline.

Impact: Enhancing utilization of the Crisis Line among high-risk Veterans could have a substantial impact on rates of suicidal behavior in this very high risk group. If found to be effective, the CLF approach could be easily expanded to other settings and could, over time, have a meaningful impact on VA-wide rates of fatal and non-fatal attempts. This study also has the potential to significantly advance the science supporting the potential utility of Crisis Lines, which has broad-ranging importance for suicide researchers and policymakers both inside and outside VA.

Principal Investigator: Mark Ilgen, PhD, is part of HSR&D's Center for Clinical Management Research (CCMR) in Ann Arbor, MI.

Facilitating Use of the Veterans Crisis Line in Veterans at High Risk for Suicide project abstract