Peer Mentorship to Reduce Suicide Attempts Among High-Risk Adults

Amid consistently worsening suicide rates, in 2012 the U.S.Surgeon General's National
Strategy for Suicide Prevention proposed to "change the narrative" about suicide prevention
to include a focus on promoting hope and belongingness. Despite hopelessness and thwarted
belongingness being among the most replicated risk factors for suicide, many widely
implemented suicide prevention efforts instead emphasize the identification of acute suicide
risk and referral to mental health treatment services. However, there are very few health
service interventions known to reduce suicides among those identified as high risk. Those
interventions shown to be effective have not achieved the wide scale implementation necessary
to alter the trend of increasing suicide deaths. New interventions are needed, and one
promising, scalable intervention with a novel approach to addressing the risk factors
advocated by the Surgeon General is peer mentorship. A peer mentorship intervention, PREVAIL,
has been piloted in a two-site randomized controlled trial (N=70) and is acceptable and
feasible with enrollment of nearly half of eligible high-risk patients, mean completion of
over 6 mentorship sessions, and 85% of sessions meeting fidelity standards for addressing the
intended targets of hope and belongingness.

The aims of this hybrid effectiveness-implementation study are:

Specific Aim 1: Determine the effectiveness of the PREVAIL peer mentorship intervention for
reducing suicide attempts and suicidal ideation among recently hospitalized adult psychiatric
patients at high risk for suicide.

Specific Aim 2: Examine the mechanisms of peer mentorship by measuring the effects of PREVAIL
on potential mediators,including hope and belongingness.

Specific Aim 3: Identify barriers and facilitators to implementation of PREVAIL.