NRSA Fellowship for Martina Fruhbauerova: Randomized Controlled Trial Of A Single-Session Mechanism-Focused Intervention For Suicidal Thoughts And Behaviors

PROJECT SUMMARY/ABSTRACT Suicide is a leading cause of death in the U.S. and worldwide. The number of people who experience suicidal thoughts and behaviors (STBs) is even larger. Although effective for treating suicidal behaviors, traditional outpatient treatments for suicidality are time intensive. Given that the average number of sessions attended by an individual is five, suicidal individuals are unlikely to receive an adequate dose of these treatments. Additionally, there are too few mental health clinicians, and many providers are unwilling to treat suicidal individuals. To address accessibility barriers, a number of brief suicide-specific interventions have been developed. Brief interventions, including single sessions, reduce future suicidal behavior and increase the likelihood of attending outpatient appointments. Extant treatments (both brief and traditional) appear to have a limited impact on suicidal ideation. However, suicidal ideation as an “upstream” target may have an impact on suicide attempts and deaths “downstream.” In line with NIMH’s RDoC initiative, focusing on the core mechanisms that give rise to suicidal ideation may represent a more potent and parsimonious approach to care. ‘Ideation-to-action’ theories outline specific mechanisms that contribute to the onset and maintenance of STBs. These mechanistic theories point to a limited number of potentially malleable processes (i.e., hopelessness, perceptions of social relatedness) that can become the focus of intervention, yet this empirical literature has not been incorporated into treatment development. The proposed study will compare a novel, mechanism-focused, Single Session Intervention for STBs (SSI-STB) to treatment as usual (TAU) on an inpatient psychiatric unit. We aim to test whether targeting the putative processes (hopelessness and negative perceptions of social relatedness) that maintain STBs indeed engage those mechanisms and, consequently, prevents future STBs. The applicant will also examine whether patients who receive the SSI-STB are more likely to attend their follow-up mental health appointment relative to TAU. Participants admitted for suicidal ideation and/or suicide attempt to the inpatient psychiatric unit will be randomized to the SSI-STB or TAU conditions, receive the intervention that corresponds to their assigned condition, and will complete a post-intervention self-report assessment directly after the intervention, and follow-up assessments at one week and one month after discharge. Results will help us address the critical need of integrating established mechanisms that maintain suicidality into a disseminable intervention for STBs. Moreover, this application describes an excellent research environment for the proposed work, supported by a collaborative mentorship team with relevant expertise. The applicant will learn new skills in mechanism-focused treatment development. This clinical trial research experience will be invaluable toward the applicant’s goal of becoming an independent physician/scientist.