More than 1800 suicides occur each year in Veterans Health Administration (VHA) patients. Veterans are at significantly elevated risk for suicide compared to the general US population, and the Veterans Crisis Line was developed to provide easily accessible support during high-risk periods in order to prevent suicidal behaviors among Veterans and VHA patients. Observational data highlight the potential 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, the study team developed a new intervention, Crisis Line Facilitation (CLF), a brief, motivational interviewing-based therapy aimed at addressing Veterans' perceived barriers and facilitators of crisis line use during periods of suicidal crisis. The proposed study will evaluate 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.
The objectives of this randomized controlled trial are to: (a) test the impact of CLF on Veterans Crisis Line utilization, as well as outpatient mental health treatment utilization, (b) test the effect of CLF on likelihood of future suicide attempts, (c) test the extent to which post-baseline use of the Veterans Crisis Line mediates the effect of CLF on suicidal behaviors, and (d) understand barriers and facilitators of implementation of CLF, based on qualitative interviews with treatment providers and at-risk Veterans
The present study will screen approximately 1042 Veterans hospitalized for a recent suicidal crisis (significant ideation, plan and/or recent attempt requiring psychiatric hospitalization) at one of two VHA inpatient psychiatry units to determine whether they have previously called the Veterans Crisis Line. A sample of 500 participants who have 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 (EUC) condition. 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.
Recruitment for the project is ongoing; therefore, analyses have not yet begun. Our anticipated findings are that at follow-up assessments Veterans who were randomly assigned to CLF, compared to those assigned to EUC, will be: (1) significantly less likely to make a suicide attempt, and (2) significantly more likely to call the Crisis Line and initiate or continue outpatient mental health treatment.
Enhancing utilization of the Crisis Line among high-risk Veterans could have a significant impact on suicidal behaviors 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 VHA-wide rates of fatal and non-fatal attempts. Qualitative data gathered on barriers and facilitators of utilization of the CLF intervention will inform future efforts to implement CLF. This design has the potential to significantly advance the science supporting the potential utility of Crisis Lines which has broad-ranging importance for suicide researchers and policy-makers both inside and outside VHA.
- Ilgen MA, Goldman E. Cognitive behavior therapy for suicide in Veterans with substance use disorders. Suicide Prevention [Cyberseminar]. 2017 Jun 12.