Treatment for Relationships and Safety Together (TR&ST) for Suicide

Phase-Based Estimates
1
Effectiveness
1
Safety
VA San Diego Healthcare System, San Diego, CA, San Diego, CA
Suicide+1 More
Treatment for Relationships and Safety Together (TR&ST) - Behavioral
Eligibility
18+
All Sexes
Eligible conditions
Suicide

Study Summary

This study is evaluating whether a therapy which focuses on improving relationships may help reduce suicide risk.

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Eligible Conditions

  • Suicide
  • Relation, Interpersonal

Treatment Effectiveness

Study Objectives

This trial is evaluating whether Treatment for Relationships and Safety Together (TR&ST) will improve 1 primary outcome, 5 secondary outcomes, and 6 other outcomes in patients with Suicide. Measurement will happen over the course of Delivered at baseline, 7 weeks after baseline (mid-treatment), 13 weeks after baseline (post-treatment), and 25 weeks after baseline.

Week 13
Satisfaction with Care
Week 25
Change in negative communication from baseline
Change in perceived burdensomeness and thwarted belonging from baseline
Change in positive bonding from baseline
Change in positive communication from baseline
Change in relationship conflict from baseline
Change in relationship satisfaction from baseline
Change in severity of depression from baseline
Change in severity of suicidal ideation from baseline
Changes in Posttraumatic Stress Disorder severity from baseline
Outpatient Engagement
baseline
Expectations of Treatment

Trial Safety

Trial Design

2 Treatment Groups

VA Standard Suicide Intervention
Treatment for Relationships and Safety Together (TR&ST)

This trial requires 144 total participants across 2 different treatment groups

This trial involves 2 different treatments. Treatment For Relationships And Safety Together (TR&ST) is the primary treatment being studied. Participants will all receive the same treatment. There is no placebo group. The treatments being tested are not being studied for commercial purposes.

Treatment for Relationships and Safety Together (TR&ST)
Behavioral
TR&ST consists of eleven 90-minute sessions delivered in three phases. During phase one, couples receive a tailored cognitive-behavioral conceptualization of suicide and relationship distress based on clinical interview, as well as psychoeducation about their bidirectional influences. They also engage in behavioral activation focused on positive couple activities, emotion regulation, distress tolerance, and conflict management strategies. In phase two, couples learn communication skills and discuss suicidal thoughts and behaviors, as well as their relationship challenges that interact with suicidal thoughts and behavior. Phase three is focused on conjoint thought challenging to shift dysfunctional cognitions related to suicide and relationship problems.
VA Standard Suicide Intervention
Behavioral
Our active control condition is standardized and contains the elements of standard practice suicide-specific intervention delivered at the VA, which include: 1) suicide risk assessment using the CSSR-S, 2) VA Safety Planning Intervention, 3) timely referral to VA mental health outpatient care, including couples intervention (engagement will be tracked), and 4) Suicide Prevention Coordinator (SPC) follow-up contacts (which have been found to significantly reduce suicidal behavior).

Trial Logistics

Trial Timeline

Approximate Timeline
Screening: ~3 weeks
Treatment: Varies
Reporting: delivered at baseline, 7 weeks after baseline (mid-treatment), 13 weeks after baseline (post-treatment), and 25 weeks after baseline
This trial has the following approximate timeline: 3 weeks for initial screening, variable treatment timelines, and roughly delivered at baseline, 7 weeks after baseline (mid-treatment), 13 weeks after baseline (post-treatment), and 25 weeks after baseline for reporting.

Closest Location

VA San Diego Healthcare System, San Diego, CA - San Diego, CA

Eligibility Criteria

This trial is for patients born any sex aged 18 and older. There are 6 eligibility criteria to participate in this trial as listed below.

Mark “yes” if the following statements are true for you:
Veterans who report present suicidal ideation CSSR-S > 2 ("Active thoughts of killing oneself") in past 1 month and/or a suicide attempt in the prior 3 months,
an intimate partner who is willing to participate.
in the committed relationship for at least 6 months
plans to remain in the San Diego region for 7 months
capable of informed consent
agree to have assessment and treatment sessions audio recorded.

Patient Q&A Section

Please Note: These questions and answers are submitted by anonymous patients, and have not been verified by our internal team.

What is suicide?

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Suicide is a major cause of death among adolescents and young adults. Although there is little awareness among the general public, the incidence of suicide is still significant in the Philippines.

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What are the signs of suicide?

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Suicide may result in the dead being found at different times depending on the method of suicide, with fingerprints not being there earlier than between 48 hours and 2 days. The most common sites of suicide are the brain, particularly the frontal lobe in those found by suicide by jumping and hanging in which death may occur up to 4 hours after the actual kill. We think that in an attempt to take a quick and painless end, people in early stages tend to be more impulsive. This is in contrast to those attempting to kill themselves by asphyxiation, who may have lost impulse control and acted as if they possessed a weapon to defend their self-image.

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How many people get suicide a year in the United States?

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In the United States, the prevalence of suicidal behavior in adolescents and young adults is very high, and suicidal behavior results in about 26,000 deaths each year (a rate about 4-fold higher than the number of deaths from all other causes). Given the public health significance of the problem, a number of prevention programs using different methods are under development, although few of them have been tested in randomized clinical trials. Adolescent suicide is an important and serious public health issue, but information available to policy makers has limitations.

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What are common treatments for suicide?

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Many cases of suicide are not addressed using pharmacotherapy, despite evidence of efficacy from clinical research. These cases may not be addressed using behavioral therapies. A comprehensive assessment is a prerequisite to establishing a coherent treatment plan.

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Can suicide be cured?

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Results from a recent paper does not support the claims of proponents of psychotherapy who claim that suicidal patients can recover if they are treated with psychotherapy, but does suggest that patients in the long term may not benefit. The study suggests that, although it is impossible to guarantee a cure, therapy may be able to reduce some people's risk of suicide. Future randomized controlled trials might address this limitation by randomising patients to a number of treatments, of which only one is intended to treat the suicidal state, rather than having all patients in the trial receive their treatments as usual.

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What causes suicide?

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Suicide is a complex issue with many different causes. The most common causes are mental illness: depression, substance abuse, and self-harm. The majority are not treatable. However, some are reversible with counselling, and some have no identifiable cause. Depression often accompanies suicidal ideation and attempts. Suicide is an increasingly pressing issue, especially in the workplace. The most effective prevention method is public health measures, such as raising awareness in society and improving policy.

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What is the primary cause of suicide?

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The major risk factors for suicide are mental disorders, unemployment, and a history of a prior suicide attempt. The major risk factors for drowning are gender, a history of substance abuse, a history of water-related disorders, and a history of a prior drowning. The major risk factor for hanging is being male.

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What is the latest research for suicide?

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There is a great deal of variability in studies regarding suicide rates. [The most recent available studies suggest that suicide rates in the United States have been declining since 2000] Increasing rates of mental health services for patients have not had a huge impact on decreasing suicide rates, but additional funding is needed for mental health services research. More research is needed to establish the relationship between patient age, sex, and gender and suicide rates. It is important to understand what is the risk factor(s) for suicide. There are many possible explanations. One possibility is that suicide risk is highest in those who are not receiving treatment for substance use. Additional studies need to be done to examine the link between socioeconomic factors and suicide risk.

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What are the common side effects of treatment for relationships and safety together (tr&st)?

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This is an important area of awareness to help ensure that any form of physical or verbal violence is not tolerated between patient and physician. Although many factors contribute to this, it is the responsibility of the physician or health care practitioner to ensure patient safety by being knowledgeable in and accepting the fact that the relationship can be difficult and the safety of each other. Physicians need to ensure that they understand and incorporate the following into their treatment and counseling strategies to increase patient safety.

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Has treatment for relationships and safety together (tr&st) proven to be more effective than a placebo?

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There was no difference in the likelihood of suicide for individuals who had received treatment for relationship and safety (tr&st) versus a placebo. More research is needed to determine which clinical interventions, which may include psychosocial, psychiatric and medical treatment, most impact treatment adherence and relationship/safety outcomes.

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Does suicide run in families?

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We found a strong familial aggregation of suicide in our elderly population. However, the magnitude of the familial effect was very small for all types of suicide, which suggests that suicide is neither genetically nor phenotypically familial.

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How does treatment for relationships and safety together (tr&st) work?

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Evidence-based, evidence-informed treatment of intimate partner violence is effective both in terms of reductions in distress and in reducing the number of violent episodes across all types of violence. It has also been shown that couples' motivation to seek treatment is a key determinant of treatment outcomes. This evidence also shows that an aggressive and integrated treatment approach is more effective than a single intervention; that is, couples' engagement may be enhanced by integrating risk reduction and treatment for both partners simultaneously.

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