Caring Cards to and From Veterans: A Peer Approach to Suicide Prevention

• ClinicalTrials.gov Identifier: NCT04486677
• Recruitment Status: Completed
• First Posted: July 24, 2020
• Last Update Posted: May 6, 2023
• Sponsor: VA Office of Research and Development
• Information provided by (Responsible Party): VA Office of Research and Development

Study Description

Brief Summary:

Veteran suicide is a national problem; social disconnection is an important contributor to suicide risk. This pilot study will recruit Veterans to take part in a peer-centered intervention called Caring Cards (CC). CC gives Veterans who have a history of increased suicide risk the opportunity to make cards that are then sent to Veterans who are currently at high-risk for suicide. This study will directly benefit Veterans and contribute to the quality of services provided by VA by creating a safe, creative space for Veterans with lived experience related to suicide risk to join together to provide messages of hope, community, and resilience to their peers at risk for suicide. Helping Veterans support one another provides a bridge for social connection, which may help prevent Veteran suicide. This intervention may also improve Veterans' satisfaction with VA healthcare and engagement with mental health treatment.

Condition or disease	Intervention/treatment	Phase
Feasibility; Acceptability; Thwarted Belongingness; Perceived Burdensomeness; Suicide Risk; Social Connectedness	Behavioral: Caring Cards Group; Behavioral: Caring Cards Recipients	Not Applicable

Detailed Description:

There is a strong need to develop, evaluate, and implement translatable interventions aimed at reducing Veteran suicide. Caring contacts for suicide prevention (i.e., staff send supportive letters to patients following psychiatric inpatient stays) is an empirically supported, low-cost method for meaningfully reducing suicide risk and hospitalization readmissions and, has been studied and applied in Veterans/VA settings. Peer support (i.e., persons with lived mental health experience) in mental health recovery is another empirically supported approach. Peers' involvement in mental healthcare improves patients' social functioning and community integration, as well as reduces self-stigma and functional impairment. This study focuses on the Caring Cards (CC) intervention, which is a novel integration of caring contacts and peers. In CC, outpatient Veterans with lived mental health experience (peers) create hope-filled and inspiring cards that are then sent to other Veterans struggling with mental health concerns. By design, CC increases social connectedness among participants to reduce suicide risk, which is strongly associated with social disconnectedness. Indeed, there are two evidence-based social risk factors of suicide: thwarted belongingness (TB; feeling like one does not belong) and perceived burdensomeness (PB; feeling as though one's existence is a burden on others). CC combines both caring contacts and peers to specifically target reductions in TB and PB by increasing social connectedness. This study aims to establish the feasibility and acceptability of CC. The investigators' initial quality improvement project provided strong preliminary evidence for the feasibility and acceptability of the CC. The current study is a single-site, 2-year pilot trial that employs an open-trial, pre/post research design. The investigators propose to recruit outpatient Veterans with a history of high suicide risk to make up the CC group and serve as the card-makers (CMs). The investigators will recruit outpatient Veterans who are currently at high-risk for suicide to be the card-recipients (CRs). The primary outcome (Aim 1) is to establish feasibility and acceptability of CC. Aim 2 will examine CC's ability to reduce the primary outcomes (TB and PB) among CMs and CRs. Aim 3 will preliminary evaluate CC's ability to increase social connectedness, as well as reduce suicide risk (i.e., suicidal ideation and behavior) among CMs and CRs. CMs will meet in weekly groups, each for six months, over the course of one year; CRs will receive a total of six cards, one per month. Monthly meet-up groups will also be an optional venue for CMs and CRs to meet each other in-person. Baseline and follow-up assessments will be completed at start and one month after final group for CMs, or one month after the final card for CRs. This project builds on the investigators' preliminary data which indicate that Veteran CMs are interested in and find participating in CC groups highly meaningful, and Veteran CRs enjoy receiving the cards, want to receive more, and describe them as inspirational and empowering. This project is innovative in its utilization of peers to facilitate suicide prevention and social recovery among Veterans at risk for suicide by specifically targeting TB and PB. It is also unique in that it simultaneously targets two populations (outpatient Veterans with a history of, and those with current suicide risk), which have not previously been examined with traditional caring contacts. This research directly responds to the National Prioritized Research Agenda for Suicide Prevention. This study directly supports RR&D's mission and is aligned with VA's 2018-2028 National Strategy for Preventing Veteran Suicide. The investigators expect that these data will inform best practices in suicide prevention and social recovery for Veterans at risk for suicide.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 80 participants
• Allocation: Non-Randomized
• Intervention Model: Single Group Assignment
• Intervention Model Description: The current study is a single-site, 2-year pilot trial that employs an open-trial, pre/post research design. This study's primary aim is to establish the feasibility and acceptability of Caring Cards for Veterans, a peer-centered intervention that facilitates suicide prevention and social connectedness.
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Caring Cards to and From Veterans: Feasibility and Acceptability of a Peer Approach toSuicide Prevention and Recovery
• Actual Study Start Date: January 1, 2021
• Actual Primary Completion Date: September 1, 2022
• Actual Study Completion Date: November 30, 2022

Arms and Interventions

Arm	Intervention/treatment
Caring Cards Group; Group of Veteran card-makers.	Behavioral: Caring Cards Group; Group of Veteran card-makers.
Caring Cards Recipients; Group of Veteran card-recipients.	Behavioral: Caring Cards Recipients; Group of Veteran card-recipients.

Outcome Measures

Primary Outcome Measures :

1. Feasibility [ Time Frame: Through study completion, an average of 2 years ]
   Feasibility will be measured by the proportion of Veterans 1) referred for screening, 2) determined eligible, 3) enrolled/completed baseline, and 4) complete follow-up assessments.
2. Intervention Satisfaction Questionnaire (Acceptability) [ Time Frame: Through study completion, an average of 2 years ]
   Intervention Satisfaction Questionnaire will be collected from participants following intervention delivery to measure acceptability of the Caring Cards intervention.

Secondary Outcome Measures :

1. Interpersonal Needs Questionnaire (INQ-12) Change from Baseline [ Time Frame: Change from baseline, an average of 9 months ]
   At baseline and follow-up, Veterans will complete the INQ-12 to assess for thwarted belongingness and perceived burdensomeness.
2. Suicide Risk Change from Baseline [ Time Frame: Change from baseline, an average of 9 months ]
   At baseline and follow-up, Veterans' suicide risk will be assessed.
3. NIH Toolbox Adult Social Relationships Scales Change from Baseline [ Time Frame: Change from baseline, an average of 9 months ]
   At baseline and follow-up, Veterans will complete the NIH Toolbox Adult Social Relationships Scales to assess social connectedness.

Eligibility Criteria

• Ages Eligible for Study: Child, Adult, Older Adult
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• For card-makers:

  • VA San Diego Healthcare System (VASDHS) Veteran with an inactive high-risk flag,
  • 18 years of age or older,
  • access to transportation to attend the group (if held in person)
  • if groups are held remotely due to COVID-19, access to reliable technology and WiFi to participate via WebEx
  • decisional capacity.

• For card-recipients:

  • VASDHS Veteran with an active high-risk flag,
  • 18 years of age or older, and
  • decisional capacity.

Exclusion Criteria:

-For card-makers and recipients:

• the absence of a mailing address or working phone number,
• inability to read and writer in English, and
• previous or current experience with Caring Cards.

Contacts and Locations

Locations

United States, California

VA San Diego Healthcare System, San Diego, CA

San Diego, California, United States, 92161-0002

Sponsors and Collaborators

VA Office of Research and Development

Investigators

• Principal Investigator: Eric L Granholm, PhD; VA San Diego Healthcare System, San Diego, CA

  Study Documents (Full-Text)

Documents provided by VA Office of Research and Development:

Informed Consent Form  [PDF] August 27, 2020

More Information

• Responsible Party: VA Office of Research and Development
• ClinicalTrials.gov Identifier: NCT04486677
• Other Study ID Numbers: D3445-P
• First Posted: July 24, 2020
• Last Update Posted: May 6, 2023
• Last Verified: May 2023

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Yes
• Plan Description: One or more data sets without personal identifiers will be generated during the data analysis phase of this study. The data sets will include all data underlying any publications generated by this study and therefore these will be sufficient to reproduce or verify any published findings. Data sets without personal identifiers will be generated. Any HIPAA identifiers, or combinations of variables that could be used for re-identification, will be excluded, as will any proprietary information. The plan does not include any access to individually identifiable or proprietary data. Therefore, this plan will ensure the protection of personal privacy, the confidentiality of individually identifiable private information, and the security of proprietary data and information.
• Supporting Materials: Study Protocol; Statistical Analysis Plan (SAP); Informed Consent Form (ICF); Clinical Study Report (CSR); Analytic Code
• Time Frame: Beginning 3 months and ending 5 years following article publication.
• Access Criteria: Final data sets underlying publications resulting from this research will be shared upon written request. Requests for access must be made in writing signed by a requestor from the United States and include an email address for delivery and an assurance that the recipient will not attempt to identify or re-identify any individual. The request should reference the publication underlying the request. Requests may be made to the Principal Investigator/lead point-of-contact for the publication. If the investigator leaves the VASDHS the requests may be sent to the Associate Chief of Staff for Research.

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No
• Product Manufactured in and Exported from the U.S.: No

Keywords provided by VA Office of Research and Development:

Veterans; Suicide; Thwarted belongingness; Perceived burdensomeness; Social connectedness

Additional relevant MeSH terms:

Suicide; Self-Injurious Behavior; Behavioral Symptoms