Teachable Moment Brief Intervention for Veterans Following a Suicide Attempt

A total of 50 patients will be recruited from the inpatient psychiatry unit for the study. A
member from the research team will obtain informed consent for the participants and then
administer the baseline assessment battery. Patients will then be randomized to either (a) an
experimental group receiving TMBI + follow-up consultation or (b) a group receiving care as
usual. Patients randomized to the experimental group will receive the intervention prior to
discharge from the hospital, most likely on the same day as the baseline assessment battery.
Patients receiving the experimental intervention will then be asked to complete a brief
post-intervention client satisfaction survey administered by a research team member. All
study participants will then complete telephone follow-up assessments at 1 and 3-month time
points administered by members of the research team and supervised by the PI. Additionally,
patient electronic medical records will be abstracted to document the following health
services and clinical characteristics in the 12 months following enrollment in the study:
death for any reason, inpatient hospitalization (both medical/surgical and psychiatric),
emergency department visits, suicide attempt and other forms of self-directed violence, all
outpatient appointments with VA service providers, and diagnosis. The PI will rate the TMBI
sessions for the interventionists. When the PI delivers the intervention, a trained member of
the research team will review the PI's sessions and rate for adherence. The intervention will
consist of no more than 90 minutes (expected mean is 45 minutes for the intervention based
upon previous studies of the TMBI) of 1:1 interaction with a study clinician. The baseline
assessment battery will take approximately 30 minutes, the post-intervention measure will
take approximately 5 minutes, and the 1 and 3-month assessment batteries will take
approximately 30 minutes. The PI and potentially 2 to 3 members of the Suicide Prevention
Program will provide the intervention to ~25 randomized patients.

Notes will be kept on patients who decided to drop out of the intervention and/or the study.
We will examine the mean and standard deviation for the total score and individual items on
the Client Satisfaction Questionnaire. Notes will be kept documenting all contacts for
recruitment and the number of eligible patients per month. Reasons for inclusion and
exclusion of potential participants will be documented as well as reasons participants give
for choosing not to participate. Number of patients enrolled and randomized each month will
be documented. Notes will be kept of rates of on-time outcome assessments and days late and
any assessments missed or participants lost to contact.

Descriptive statistics for demographic and clinical variables will be tabulated. All scales
will be scored and subscales described. This process will include examining the data for
missing values, appropriate ranges, and outliers. Although the randomization design should
ensure balance between the two groups, it is essential to control for any known confounders
in the design and analysis to prevent a biased assessment of the brief intervention effect.
Any baseline demographic or clinical variables found to be statistically significant in the
analysis will be included as covariates in all analytic models. We will use an
intent-to-treat sample to complete our analyses. We will utilize mixed-effects regression
models to obtain between-groups effect sizes for the impact of the TMBI + consultation on
elevating motivation, hope, reasons for living and social connection.

Inclusion Criteria:

1. Veteran service member

2. Recently admitted to an inpatient psychiatry unit at the VAMC site following a suicide
attempt

3. 18 or more years of age

4. Consents to participate in baseline and follow-up interviews and gives permission to
review records for previous year and subsequent year.

5. Consents to randomization and participation in TMBI + follow-up or Care as Usual

6. Consents to audio recording in order for PI to conduct adherence rating

Exclusion Criteria:

1. Significant psychosis, cognitive, or other problems that prevent participant from
understanding the study procedures or renders them unable to provide informed consent
(suggesting that psychosocial therapeutic care is contra-indicated)

2. Judicially-ordered to treatment (e.g., subsequent to domestic violence) such that
participation in study procedures could not be considered voluntary and participant is
not free to drop out without significant negative consequences.