Development of a Novel Couples-Based Suicide Intervention: Treatment for Relationships and Safety Together (TR&ST)

Background: Suicide is one of the leading causes of death in the United States and worldwide, with suicide rates among U.S. military veterans doubling (27.7 per 100,000) the rate of civilian levels (14.7 per 100,000). Despite a rise in prevention efforts, rates have continued to increase. Theories of suicide and rehabilitation

psychology stress the importance of the person-environment interaction in contributing to one’s disability experience. Specifically, research has consistently found that the most frequent precipitant of suicide is a problem with a romantic partner. Conversely, people with better relationship functioning are less likely to have

suicidal thoughts. The International Classification of Functioning, Disability and Health (ICF) identifies social engagement and communication as important components of functioning. Prevention of suicide in at-risk veterans is of vital importance and the quality of one’s intimate relationship is an understudied intervention

target for suicide prevention. This proposal refines and evaluates preliminary efficacy of the first couples-based suicide-specific intervention—Treatment for Relationships and Safety Together (TR&ST). Significance/Innovation: Suicide prevention is the top clinical priority for VA/DoD. The importance of including

family members in Veterans’ suicide-related care is a critical component of the National Strategy for Preventing Veteran Suicides 2018-2028 and key finding from VA/DoD patient focus groups conducted for the 2019 VA/DoD Clinical Practice Guidelines for the Assessment and Management of Patients at Risk for Suicide.

Innovative aspects of this CDA-2 proposal directly address several components of national reports and include: 1) The first couples-based suicide-specific intervention and the first suicide-specific intervention to target interpersonal functioning factors identified by suicide theories and rehabilitation psychology (i.e., effective

communication and interpersonal engagement); 2) Veteran-centric choice between home-based telemental health and office-based care in order to increase access; and 3) Improved data analytic quality of Veteran suicidality by examining both Veteran and partner reports of suicide related risk factors (the first suicide-

specific treatment study to do this). Methodology: The proposed 5-year study consists of two phases. Phase 1: treatment refinement with 10 couples (N=20) and Phase 2: pilot Randomized Controlled Trial (RCT) of TR&ST compared to VA Standard Suicide Intervention with 60 couples (N=120). The intervention period is 13 weeks and the entire study period

is approximately 7 months. Couples in both phases will be quantitatively assessed at baseline, mid-treatment, post-treatment, and 3-months post-treatment (and qualitatively interviewed following each TR&ST module). The primary outcome to be evaluated is change in suicidal ideation severity. Secondary outcomes concern

changes in interpersonal functioning. Aims: Aim 1 (Phase 1): Refine TR&ST in a population of Veterans with active suicidal ideation. Aim 2 (Phase 2): Evaluate treatment feasibility and acceptability of TR&ST. Aim 3 (Phase 2): Compare TR&ST vs. VA Standard Suicide Intervention on suicidal ideation severity and interpersonal functioning (i.e., communication,

bonding, relationship satisfaction, and belonginess and burdensomeness) over 7 months. Next Steps: This Career Development Award is the first step toward developing a vital program of research within VHA focused on enhancing interpersonal functioning and suicide-related care by involving family members in treatment. If Aims are achieved, future work includes 1) an adequately powered RCT of TR&ST

vs. VA Standard Suicide Intervention 2) a more direct evaluation of telehealth for couples-based or family involvement in suicide-specific interventions, and 3) examination of moderators or groups of interest (such as women Veterans).