Randomized Controlled Trial of a Strategic Disclosure Intervention for Suicide Attempt Survivors

Suicide attempt survivors are at higher risk for subsequent suicide attempts and may struggle to find supportive confidants for discussing suicidality. Overt stigmatizing reactions, fear of stigma, internalized stigma, or perceived futility interfere with help-seeking for suicidality. However, disclosure of suicidality can enhance support networks, provide opportunity for self-reflection, and challenge stigma. A peer-led strategic disclosure intervention (The 2Share Program) was developed through a collaborative process with suicide attempt survivors and aids participants in evaluating the benefits and risks of disclosure, considering ways to disclose, and developing disclosure scripts. A pilot randomized controlled trial (RCT) with community-dwelling attempt survivors (n=38) found that intervention participants had significant decreases on internalized stigma, depression, and increased self-esteem as compared with the control group; however, this study was small and did not evaluate changes in current suicidality, help-seeking behavior, or disclosure outcomes over time. The aim of the proposed research is to conduct a larger-scale RCT (n=100) of the 2Share program for recent (<3 years) suicide attempt survivors, with one-month follow-up. Outcome measures will include internalized stigma, depression, self-esteem, suicidality, secrecy/disclosure, disclosure-related confidence, and help-seeking. We expect that results will replicate previous findings on internalized stigma, depression, and self-esteem, and that intervention participants will have reductions in suicidality, increases in help-seeking attitudes, and increased disclosure/ disclosure confidence. The intervention will be co-facilitated by two trained individuals with lived experiences of suicidality (peers) but who are at least three years into recovery. Participants will be recruited in cohorts of 20 (10 intervention; 10 control). Following random assignment to condition (intervention versus control), participants will complete electronic baseline questionnaires, including demographic questionnaires and outcome measures. Intervention participants will complete the program in three 2-hour sessions (conducted weekly). All participants will complete the electronic post-questionnaire three weeks after the baseline questionnaire, and again at one-month post-intervention (7 weeks after baseline).