Caring Letters for Military Suicide Prevention

• Suicide Mortality Rates [ Time Frame: Study Completion (2 years) ] [ Designated as safety issue: No ]
  Death Certificates as recorded in the Center for Disease Control (CDC's) National Death Index Plus(NDI-Plus) will be reviewed. The Social Security Administration Master Death File will also be used.
  
  

• Patient Health Questionnaire (PHQ-9) [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  The PHQ-9 is the depression scale of the PHQ and consists of nine items that specifically target the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnositc criteria for major depressive disorder.
  
  
• Suicide Ideation Scale (SIS) [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  The 10 item Suicidal Ideation Scale (Rudd) provides critial information about the presence or absence of suicidal thinking, the intensity of those thoughts, and the presence or absence of prior suicide attempts.
  
  
• Interpersonal Needs Questionnaire (INQ) [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  The 18 item Interpersonal Needs Questionnaire aims to measure the following two constructs: thwarted belongingness and perceived burdensomeness.
  
  
• Acquired Capability for Suicide Scale (ACSS) [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  The 20 item Acquired Capability for Suicide Scale aims to measure the construct of acquired capability for lethal self-injury.
  
  
• Patient Satisfaction Survey [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  The Patient Satisfaction Survey includes 13 questions regarding satisfaction with the interview process.
  
  
• Time to Suicidal Behavior [ Time Frame: Study Completion (2 years) ] [ Designated as safety issue: No ]
  This is a survey that will assess participant suicidal behaviors and medical/psychiatric treatment utlization over the previous two years.
  
  
• Medically Admitted Self-Inflicted Injuries [ Time Frame: Study Completion (2 years) ] [ Designated as safety issue: No ]
  Suicide behaviors requiring hospital admission will be tracked by verifying patient electronic medical record with time to suicidal event will be longer among participants receiving the Caring Letters intervention compared to the ususal care condition.
  
  
• Patient Health Questionnaire (PHQ-9) [ Time Frame: Study Completion (2 years) ] [ Designated as safety issue: No ]
  The PHQ-9 is the depression scale of the PHQ and consists of nine items that specifically target the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnositc criteria for major depressive disorder.
  
  
• Suicide Ideation Scale (SIS) [ Time Frame: Study Completion (2 years) ] [ Designated as safety issue: No ]
  The 10 item Suicidal Ideation Scale (Rudd) provides critial information about the presence or absence of suicidal thinking, the intensity of those thoughts, and the presence or absence of prior suicide attempts.
  
  
• Interpersonal Needs Questionnaire (INQ) [ Time Frame: Study Completion (2 years) ] [ Designated as safety issue: No ]
  The 18 item Interpersonal Needs Questionnaire aims to measure the following two constructs: thwarted belongingness and perceived burdensomeness.
  
  
• Acquired Capability for Suicide Scale (ACSS) [ Time Frame: Study Completion (2 years) ] [ Designated as safety issue: No ]
  The 20 item Acquired Capability for Suicide Scale aims to measure the construct of acquired capability for lethal self-injury.
  
  
• Patient Satisfaction Survey [ Time Frame: Study Completion (2 Years) ] [ Designated as safety issue: No ]
  The Patient Satisfaction Survey includes 13 questions regarding satisfaction with the interview process.
  
  

This social/ behavioral study is a five year multi-site randomized controlled trial that will compare the Caring Letters intervention (with usual care) to usual care without the caring letters. Participants will be recruited from inpatient psychiatry units of collaborating military and Veterans Affairs (VA) sites and randomized to either a group that receives letters (Caring Letters group) or a group that does not receive letters (Usual Care group). The methodology of the intervention is updated with emails instead of postal letters. This study fills an important gap in the evidence base for the Caring Letter intervention through a methodologically rigorous research design.