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Principal Investigator: Marianne Goodman
Organization: JAMES J PETERS VA MEDICAL CENTER
Fiscal Year: 2024
Funding agency: Veterans Affairs
Despite the enrichment of VA suicide prevention services and implementation of the national
suicide hotline, Veteran suicide completions occur 20 times per day and suicide attempts
numbered over 15,000 in 2012. These data underscore the urgency of developing additional
interventions targeting suicidal Veterans. The construction of a Suicide Safety Plan (SSP); a
“best practice,” is mandated throughout the VA system, and a vital component of the VA’s
coordinated effort at suicide prevention and recovery. Safety Planning in Veterans presenting to
an emergency room has been shown to decrease suicide behavior. To our knowledge, there are
currently no recommended guidelines or mechanisms for refinement of the SSP in adult
populations beyond its initial development. “Project Life Force” (PLF), a novel suicide safety
planning group intervention has been designed to fill this critical gap and provide a mechanism
to develop and enhance suicide safety planning over time. PLF, a 10-session, group
psychotherapy intervention, combines Dialectical Behavioral Therapy (DBT) skill based and
psychoeducational approaches, to enhance suicide safety planning 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 and also receive lessons on gun safety and minimizing access to lethal means,
augmenting physical well being and strategies how to share their plan with family/significant
others and their treatment team. Importantly, the group format mitigates loneliness and fosters
increased “belongingness,” both key risk factors for suicide. Additionally, PLF’s weekly format
facilitates VA-mandated monitoring for any Veteran placed on the suicide “high risk” list. PLF
received pilot SPiRE funding from the VA Rehabilitation and Research Development in 2015 to
finalize the development of the intervention’s manual and pilot the intervention in Veterans.
Preliminary data suggests high levels of feasibility, and acceptability. 100% of participants
developed updated safety plans and increased use patterns and a significant decrease in
suicidal ideation.
This project’s aim is to conduct a multi-site (James J Peters VAMC and Philadelphia VA)
randomized clinical trial (RCT) of PLF versus treatment as usual (TAU) that includes individual
telephone review of safety plans in 265 suicidal Veterans with follow up to one year. The
primary outcome variable is suicidal behavior, using a rigorous, multi-method assessments
follow-up. Secondary outcomes include depression, hopelessness and treatment utilization.
Exploratory analyzes will examine whether changes in suicide coping and levels of group
cohesion in PLF mediate treatment response. Methodological rigor includes ongoing adherence
ratings for PLF and assessment training/monitoring by an independent third site (Columbia
University).
Terms: <21+ years old><Accident and Emergency department><Active Follow-up><Adult><Adult Human><After Care><After-Treatment><Aftercare><Age><Ambulatory Care><Behavior Conditioning Therapy><Behavior Modification><Behavior Therapy><Behavior Treatment><Behavioral Conditioning Therapy><Behavioral Modification><Behavioral Therapy><Behavioral Treatment><Cannot see a future><Caring><Cognition Therapy><Cognitive Psychotherapy><Cognitive Therapy><Cognitive treatment><Combined Modality Therapy><Communities><Conditioning Therapy><Coping Skills><Data><Development><Development Plans><Development and Research><Dialectical behavior therapy><Effectiveness><Emergency Department><Emergency room><Family><Feeling hopeless><Feeling suicidal><Feels there is no future><Fostering><Friends><Friendships><Funding><Future><Group Psychotherapy><Guidelines><Guns><Hour><Individual><Intervention><Intervention Strategies><Learning><Life><Loneliness><Loss of hope for the future><Manuals><Mediating><Medical Rehabilitation><Mental Depression><Mental Health><Mental Hygiene><Methodology><Methods><Monitor><Multimodal Therapy><Multimodal Treatment><NCHS><National Center for Health Statistics><Negative about the future><No hope for the future><Outpatient Care><Participant><Pattern><Personal Satisfaction><Philadelphia><Phone><Play><Population><Psychological Health><Public Health><Publishing><R & D><R&D><Recommendation><Recovery><Rehabilitation><Rehabilitation therapy><Reporting><Research Resources><Resources><Risk><Risk Factors><Role><Safety><Site><Stress><Suicidal thoughts><Suicide><Suicide attempt><Suicide precaution><Suicide prevention><System><Telephone><Testing><Time><Training><United States National Center for Health Statistics><Universities><Update><Veterans><Work><active followup><adherence rate><adulthood><ages><behavior intervention><behavioral intervention><care as usual><cognitive behavior intervention><cognitive behavior modification><cognitive behavior therapy><cognitive behavioral intervention><cognitive behavioral modification><cognitive behavioral therapy><cognitive behavioral treatment><cohesion><combination therapy><combined modality treatment><combined treatment><commit suicide><completed suicide><coping><coping strategy><depression><design><designing><develop therapy><developmental><distress tolerance><effective intervention><emotion regulation><emotional regulation><fatal attempt><fatal suicide><follow up><follow up assessment><follow-up><followed up><followup><followup assessment><group intervention><gun><high risk><hopelessness><improved><intent to die><intervention development><interventional strategy><lonely><military veteran><mobile app><mobile application><mobile device application><multi-modal therapy><multi-modal treatment><new approaches><non fatal attempt><nonfatal attempt><novel><novel approaches><novel strategies><novel strategy><outpatient treatment><post intervention><post treatment><prevent suicidality><prevent suicide><prevention service><primary outcome><psychoeducation><randomized, clinical trials><rehab therapy><rehabilitative><rehabilitative therapy><research and development><response to therapy><response to treatment><secondary outcome><skills><social role><standard of care><suicidal><suicidal attempt><suicidal behavior><suicidal ideation><suicidal individual><suicidal morbidity><suicidal risk><suicidal thinking><suicidality><suicidality prevention><suicide behavior><suicide death><suicide hotline><suicide ideation><suicide intervention><suicide morbidity><suicide rate><suicide risk><suicides><therapeutic response><therapy development><therapy response><thoughts about suicide><treatment as usual><treatment development><treatment response><treatment responsiveness><usual care><veteran population><well-being><wellbeing>