Download Long-Term Research Objective 3.A. Determine whether treatment of

U.S. National Suicide Prevention Research Efforts: 2008-2013 Portfolio Analyses
Long-Term Research Objective 3.A.
Long-Term Research Objective 3.A.
Determine whether treatment of risk conditions (e.g., insomnia, psychosis, agitation,
parental psychopathology), including optimal adherence and complete response, mitigates
suicide risk.
Funding Organization: Department of Defense
Study Title: Brief Cognitive Therapy for Military Populations
Principal Investigator: David Rudd
Year When Study First Received Funding: 2008
Abstract: The research gap in the treatment of suicidality is considerable, particularly with military
populations, including those returning from deployment in support of OIF/OEF. Only one randomized clinical
trial targeting suicidality has been conducted with a military sample (Rudd et al., 1996). Due to these
circumstances, researching the trajectory and psychotherapeutic treatment of suicidality among military
personnel has become increasing critical. When focusing specifically on methodologically sound studies of
treatments that have effectively reduced suicide attempts, Cognitive-Behavior Therapy (CBT) emerges as the
dominant psychotherapy. CBT embodies several elements, techniques and interventions that supporting
research suggests are effective in treating suicidality, including: a theoretical model that is easily explained to
patients (specifically, learning about the relationships between cognitions, emotions, and behavioral
responses); a manual-driven approach with treatment fidelity checks; and a focus on treatment compliance,
targeting identifiable skills, and assuming personal responsibility. Brief Cognitive-Behavior Therapy (B-CBT)
includes all of the aforementioned, empirically supported treatment components of CBT. B-CBT is a 12-session
modification of a previously tested and empirically supported approach to treating suicidality (Rudd et al.,
1996; Rudd, Joiner, & Rajab, 2004). This study will be conducted at Fort Carson, targeting 150 participants.
Participants will be recruited from the appropriate clinical facilities, including the outpatient clinic, emergency
room, and inpatient facility. Those agreeing to participate will be randomly assigned to one of two conditions,
B-CBT (experimental condition) or treatment as usual (control condition). Treatment as usual is simply the
existing outpatient treatment currently available at Fort Carson. Participants will be assessed with clinician
administered interviews as well as self-report scales at intake as well as 1,3,6,12,18, and 24 months. Although
time-limited treatment of suicidality is the primary target of the project, additional elements will be explored
including prospective investigation of suicide risk factors and warning signs, as well as development of a
centralized software assessment/management tracking system for high-risk suicidal individuals. This study
design is firmly grounded in empirical support and has great potential to further our understanding of the
development and treatment of suicidality in the military population.
Funding Organization: National Institutes of Health
Study Title: Research Training for Prevention of Suicide and Psychosis: A Public Health Model
Principal Investigator: Aaron Beck
Year When Study First Received Funding: 2010
Abstract: DESCRIPTION (provided by applicant): The primary aim of this training program is to promote
academic research careers for postdoctoral trainees in researching the treatment and prevention of suicide,
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U.S. National Suicide Prevention Research Efforts: 2008-2013 Portfolio Analyses
Long-Term Research Objective 3.A.
depression, and schizophrenia. In response to a pressing need for clinical researchers to translate relevant
clinical findings Into community mental health services, this program will provide the next generation of
researchers with an understanding of the complexities involved in clinical intervention research and the
strategies to translate and disseminate such findings into public health settings. Within this context, the
program includes a focus on evidence-based interventions for mental disorders and suicide including
cognitive, behavioral, dynamic, family, and pharmacological treatments. This application requests support for
a two-year Postdoctoral Training Program (3 trainees in Year 1, 5 trainees in Years 2-5). This program will
provide trainees with knowledge and experience in the proper conduct of clinical intervention research,
ethics, human subjects issues, consent procedures, clinical measurement of symptoms, as well as in research
design, statistical analytic approaches, and preparation of peer-reviewed articles and research grant
applications. The training will be delivered through three major components: (1) a core curriculum of didactic
presentations and workshops on a variety of topics related to clinical intervention research, (2) a year-long
mentored clinical research experience with a core faculty member's research group and an optional secondary
research experience with another faculty member, and (3) a mentored independent clinical research project
that will lead to an application for independent research funding by the conclusion of this training program
(e.g., NIH K-Award, foundation grant). In addition, in order to prepare for an academic research career,
trainees will have access to a broad array of research and professional development resources, including
research meetings, statistical courses, career development mentoring and case consultations. The
internationally recognized faculty has many years of experience collaborating with one another and training
research fellows. PUBLIC HEALTH RELEVANCE: Suicide is a leading cause of death. Depression and
schizophrenia are two of the ten leading mental disorders that generate disability, and are significant risk
factors for suicide. Evaluating, refining and disseminating programs for the treatment and prevention of
suicide, depression and schizophrenia are crucial for reducing the global burden of disease associated with
these conditions.
Funding Organization: Veterans Affairs
Study Title: VA Augmentation and Switching Treatments for Improving Depression Outcomes (VAST-D)
Principal Investigator: Sidney Zisook
Year When Study First Received Funding: 2013
Abstract: The overall purpose is to determine research based 'next-steps' for outpatients with major
depressive disorder who have not had satisfactory outcomes to standard 'first-step' treatments. The primary
objective is to compare the acute (up to 12 weeks) treatment effectiveness of augmenting an antidepressant
with aripiprazole or with bupropion-SR vs. switching treatment to bupropion-SR monotherapy on symptom
remission in Veterans with Major Depressive Disorder (MDD) who have not achieved optimal response after
an adequate trial on antidepressant (SSRI or SNRI) monotherapy. The secondary objectives are to compare the
acute (up to 12 weeks) and long term (up to 36 weeks) efficacy, safety, effects on functioning, suicidality,
quality of life, anxiety and other associated symptoms, costs and cost-effectiveness of each of the three
treatments.
Funding Organization: Veterans Affairs
Study Title: Assessing Medications as Interventions to Prevent Suicide in the VHA
Principal Investigator: Eric G. Smith
Year When Study First Received Funding: 2010
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U.S. National Suicide Prevention Research Efforts: 2008-2013 Portfolio Analyses
Long-Term Research Objective 3.A.
Abstract: Background: Suicide prevention is a major clinical and programmatic focus of the VHA. For patients
with mood disorders, stronger evidence exists for lithium as a suicide preventative than any other medication.
However, the evidence base is still thin, with little randomized evidence and with observational evidence that
frequently is confounded and/or lacks active controls. Most recently, a small randomized trial comparing
lithium and divalproex for preventing suicide attempts failed to find a significant difference between the
medications, so the potential of lithium as a suicide preventative within or outside the VHA is still unresolved.
OBJECTIVE(S): The primary objective of this study is to assess, using modern comparative effectiveness
methods such as high-dimensional propensity scores, whether use of lithium is associated with reduced risks
of suicide for VHA patients compared with anticonvulsant mood stabilizers (with initial focus on valproate, the
most popular anticonvulsant mood stabilizer). Secondary objectives include assessing and accounting for
"healthy adherer" effects, risks associated with discontinuation/nonadherence that might limit usefulness in a
real-world setting, and addressing potential unmeasured confounding in administrative data through chart
review.
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