A Brief Intervention to Reduce Suicide Risk in Military Service Members and Veterans - Study 2 (SAFEMIL)

• Suicide Ideation [ Time Frame: discharge, 1 month, and 6 months post-discharge ] [ Designated as safety issue: Yes ]
  Suicide ideation will be measured using the Columbia Suicide Severity Rating Scale (C-SSRS) and the Scale for Suicide Ideation (SSI). Both measures assess for presence, intensity, frequency, and specificity of suicide related thoughts (ideations).
  
  
• Acceptability and Initiation of Mental Health Care and Substance Use Treatment [ Time Frame: discharge, 1 month, and 6-months post-discharge ] [ Designated as safety issue: No ]
  Acceptability and initiaion of mental health and substance use treatment will be assessed for using the Attitudes Toward Seeking Professional Psychological Help Scale (ATSPPH), the National Health and Nutrition Examination Survey (NHNES), and Barriers to Care Items.
  
  
• Suicide-related Coping [ Time Frame: discharge, 1 month, and 6 months post-discharge ] [ Designated as safety issue: Yes ]
  Coping strategies will be measured using a checklist of tactics and coping strategies used by individuals to cope with suicidal thoughts, feelings, and urges.
  
  

Background: Recently, the Army Suicide Event Reporting (ASER) and the Total Army Injury and Health Outcomes Database (TAIHOD) systems have indicated increasing rates of suicide among active Army, Guard, and Reserve units over the last several years. Additionally, research has indicated that veterans are more than twice as likely to kill themselves as compared to the general population. There are limited evidence-based suicide prevention interventions that have been developed for military personnel and veterans who are experiencing suicide ideation or who have made a suicide attempt.

Objectives: To evaluate the efficacy of the safety planning intervention on suicide ideation, suicide-related coping, and attitudes toward help seeking for hospitalized military personnel at high suicide risk.

Methodology: To test the efficacy of the adapted intervention, the investigators will randomize 186 patients to one of two conditions: Safety Planning for Military (SAFE-MIL) or Enhanced Usual Care (E-CARE). The SAFE-MIL condition(intervention) will consist of three targeted suicide prevention components including: a)structured risk assessment; b) strategies to increase coping with suicidal thoughts and urges in order to reduce suicide risk; and c) problem solving and motivational enhancement to increase acceptability of mental health treatment and maximize likelihood for post-discharge utilization of health services. The E-Care will consist of the usual care patients receive at an inpatient facility during their hospitalization in addition to assessment services provided by independent evaluators who work directly with our research team. Primary outcomes include suicide ideation, suicide-related coping, and acceptability and initiation of mental health care and substance use treatment in the 30 days post hospital discharge. Patients in both conditions will be assessed on the dependent measures at the time of hospital admission (i.e., baseline), at the time discharge (Follow-Up Interval 1 [FU-1]), at 1-month (Follow-Up Interval 2 [FU-2]) and at 6-month (Follow-Up Interval 3 [FU-3]).