Nurse and Peer Led Suicide Prevention in Tajikistan

Abstract This R34 application responds to RFA-MH-23-260 by adapting and piloting a novel intervention for suicide prevention in primary care for women at moderate or high risk for suicide in a low- and middle income countries. The study takes place in Tajikistan, a postwar country in Central Asia, where Dr. Weine, Dr. Pirova,

Dr. Bahromov, and other collaborators successfully implemented a D43 research capacity building project and an R21 and R01 on stepped care for women’s mental health in primary care. This study also builds on the team’s prior research that demonstrated the effectiveness of nurse- and peer-led interventions, identified risk

and protective factors for suicide among women, and on the PREVAIL peer-led suicide prevention model. The specific aims for this new project are: Aim 1: Adapt the evidence-based PREVAIL model into a new SUSTAIN nurse- and peer-led suicide prevention model in primary care for women at moderate or high suicide risk in

rural and urban Tajikistan using a participatory co-design process (the Transcreation Framework) with multi- level partners. Aim 2: Evaluate a pilot implementation of the SUSTAIN model in primary care among 96 women with moderate to high suicide risk, 48 randomized to SUSTAIN and 48 to an enhanced usual care

condition, with both groups followed for 9 months for suicidal ideations or behaviors, mental health outcomes, and mediators. Aim 3: Assess the acceptability, feasibility, appropriateness, potential for scalability and sustainability, programmatic costs, partnership, and equity of SUSTAIN to inform a future hybrid type 2

effectiveness-implementation pragmatic trial. The project will also build knowledge, skills, and capacities that will inform future research on testing and implementation of multi-level approaches to suicide prevention which can be part of an emerging national strategy in Tajikistan.