Update: VA’s Suicide Prevention Research Impact Network
In order to accelerate research that will lead to measurable improvements in the health of and care for our nation’s Veterans, VA has funded several unique and intensive health services research programs— the COnsortia of REsearch (COREs). The four currently-funded COREs—Access, Opioid Reduction and Pain Management, Virtual Care, and Suicide Prevention—focus on areas designated as priority concerns by VA. The Suicide Prevention Research Impact Network (SPRINT) CORE is dedicated to accelerating suicide prevention research that will result in interventions to reduce Veteran suicide, and to facilitating a collaborative network of both VA and non-VA researchers and Suicide Prevention Centers of Excellence.
SPRINT is led by principal investigators from across HSR&D-funded Centers of Innovation: Steven Dobscha, MD, directs the Center to Improve Veteran Involvement in Care; Mark Ilgen, PhD, is a research career scientist with the Center for Clinical Management Research; and Teresa Hudson, PhD, PharmD, is Associate Director of the Center for Mental Healthcare & Outcomes Research. SPRINT’s operational partners include: VA’s Office of Mental Health and Suicide Prevention; the Serious Mental Illness Treatment Resource and Evaluation Center; the VISN 2 Center of Excellence for Suicide Prevention; the Rocky Mountain MIRECC for Veteran Suicide Prevention; the QUERI for Team-Based Behavioral Health; and HSR&D’s Evidence Synthesis Program.
Steven Dobscha, MD
Mark Ilgen, PhD
Teresa Hudson, PhD, PharmD
Conference on VA Suicide Prevention Research
In collaboration with VA’s Office of Mental Health and Suicide Prevention, SPRINT recently held a virtual two-day conference, “Suicide Prevention Research in VA: Developing a Continuum of Intervention and Moving Us Forward.” Conference attendees reviewed the current state of evidence, operations, and research priorities—and presented a cross-section of active suicide prevention projects. The conference also engaged participants in discussion and problem-solving about the barriers and facilitators to conducting suicide prevention research, including within the context of the COVID-19 pandemic.
During FY2020, suicide prevention research funded by both VA and the Department of Defense (DoD) includes 183 active projects: 106 VA studies and 77 DoD studies. A substantial proportion of this research targets intervention development and testing, while other projects seek to understand both individual and group risk factors for suicide. Approximately half of the funded projects will look at individuals who are known to be high-risk for suicide, and the other half will address both individual and universal strategies for high-risk groups. An important distinction was made in that few active projects are examining how risk factors change over time. In addition, it was noted that despite prior studies of cognitive-behavioral treatments that show promise for improving suicide-related outcomes, there are currently no large-scale, hybrid-type studies of cognitive-behavioral therapy interventions.
During the conference, Dr. Nigel Bush of the DoD Health Agency presented a research priority gap analysis. The highest priority research gaps included:
- Lethal means safety as an intervention,
- Crisis response/safety planning to prevent suicide,
- Effective implementation of cognitive-behavioral therapy (CBT) interventions across the mental health spectrum,
- Technology-based behavioral health interventions (stand-alone) to prevent suicide, and
- Technology-based adjuncts (web, phone apps) to prevent suicide.
VA’s Office of Mental Health and Suicide Prevention also presented its current priorities as captured by the Suicide Prevention 2.0 Now Plan. These priorities overlap with research gaps identified by DoD and SPRINT, and include the following five strategic approaches:
- Lethal Means Safety: Securing Firearms, Medications, and Other Items to Save Lives
- Caring for Veterans in Specific Medical Populations
- Re-Engaging Prior VHA Users: Directly Reaching Veterans
- Suicide Prevention Program Enhancement
- Reaching All Veterans Through Powerful Messages of Hope
Using a Comprehensive Research Strategy
VA is employing a comprehensive public health strategy to address suicide prevention and research gaps by combining partnerships with communities to implement tailored, local prevention plans while focusing on evidence based clinical strategies for intervention. HSR&D investigators are contributing to these efforts through numerous studies.
In-depth reviews of the following studies were presented at the SPRINT conference.
- RCT of Behavioral Activation for Depression and Suicidality in Primary Care. Principal Investigator: Jennifer Funderburk, PhD, VA Center for Integrated Healthcare, Syracuse VA Medical Center; Wilfred Pigeon, VA Center of Excellence for Suicide Prevention, Canandaigua, New York. Depressive symptoms are the most common referral problem to integrated mental health providers within VA primary care clinics. While several evidence-based, brief psychotherapies for depression in primary care are available, the treatment duration (six to eight sessions of 30-50 minutes) does not match typical treatment formats delivered by mental health providers in primary care (i.e., one to four 15-30 minute sessions). Thus, Investigators are examining the effectiveness of a brief version of behavioral activation—an existing effective, longer treatment for depression.
- Multi-site Suicide Safety Planning Group Intervention for High-Risk Suicidal Veterans. Principal Investigator: Marianne Goodman MD, Director, James J. Peters VA Medical Center Suicide Prevention Research and Care Center. In this study, investigators will be assessing “Project Life Force” (PLF), a novel suicide safety planning (SSP) group intervention designed to fill a known critical gap in SSP—and will provide a mechanism to develop and enhance SSP over time. PLF is a 10-session, group psychotherapy intervention designed to enhance SSP development and implementation. Veterans revise their plans over several weeks while learning distress tolerance, emotion regulation, and friendship building/interpersonal skills to incorporate into their safety plans. They also receive lessons on gun safety and minimizing access to lethal means, augmenting physical wellbeing, as well as strategies on how to share their plan with family/significant others and their treatment team.
- Veteran-Informed Safety Intervention and Outreach Network. Principal Investigator: Gala True PhD, Investigator, South Central MIRECC, Southeast Louisiana Veterans Health Care System. Sixty-five percent of suicides among Veterans involve a firearm, and in highly rural states with high gun ownership rates, 84% of suicide deaths involved firearms – and 58% of Veterans enrolled in VA healthcare live in rural areas. In this study, investigators seek to identify Veteran Peer Champions to inform the work and assist with outreach activities. They also will engage key stakeholders in a series of deliberative discussion forums. Outcomes include the development and piloting of an implementation toolkit that addresses preventing suicide associated with firearms.
- The Use of Public Messaging Strategies to Facilitate Help-seeking among Veterans at Risk for Suicide. Principal Investigator: Elizabeth Karras PhD, VA Center of Excellence for Suicide Prevention. Since 2010, VA has developed a number of public messaging campaigns as part of their suicide prevention strategy to increase help-seeking in times of crisis. However, there is little research examining the effectiveness of these campaigns. In this study, investigators are identifying characteristics of effective messages that facilitate help-seeking among Veterans at high risk for suicide. Investigators are: examining Veterans’ perceptions of existing public messages designed to motivate help-seeking behaviors among those at high risk for suicide; identifying message features that influence the likelihood for help-seeking behaviors by Veterans during periods of crisis; and exploring facilitators and barriers to dissemination methods in order to effectively reach Veterans at high risk for suicide.
To learn more about the SPRINT CORE and access slides from the conference, visit the SPRINT web page.