Suicide risk interventions: A comparison of treatment dose and neural markers of treatment outcome
Project Number5I01CX002583-02
Former Number1I01CX002583-01
Contact PI/Project LeaderESTERMAN, MICHAEL
Awardee OrganizationVA BOSTON HEALTH CARE SYSTEM
Description
Abstract Text
The suicide rate among active duty service members and veterans increased substantially following the
onset of post-9/11 conflicts in Iraq and Afghanistan1. Accordingly, veteran suicide prevention has been
identified as a national healthcare and research priority2. Psychosocial interventions for suicide risk vary
substantially in dose and resource allocation. A single therapy session designed to evaluate risk factors and
provide support resources (e.g., Enhanced Crisis Response Plans [ECRP]3) has been shown to reduce risk for
future suicide attempts. Other interventions consisting of 10-12 outpatient sessions following inpatient
discharge (e.g., Brief Cognitive Behavioral Therapy for suicide prevention [BCBT]4) have been shown to
reduce suicide attempts by 50-60% relative to treatment as usual. Although both forms of intervention have
been shown to reduce risk, interventions that vary in dose and resource allocation have yet to be directly
compared, leaving two critical gaps in our ability to intervene most effectively. First, the assumption that more
time- and resource-intensive 10-12 session interventions translate to greater suicide risk reduction has yet to
be demonstrated. Second, it may be that less resource intensive interventions are adequate for some
individuals whereas others require more intensive care. To date, there is no evidence to guide what
interventions are indicated for specific clinical presentations.
Pharmacological and brain stimulation interventions for suicide risk are extremely limited. This is due, in
part, to an incomplete understanding of the neurobiological mechanisms of suicide risk. Although numerous
studies have examined cross-sectional neuroimaging correlates of current suicide ideation or compared
individuals with and without history of a suicide attempt, to date no studies have examined a) neurobiological
predictors of future suicide attempts in high-risk samples, b) how changes in neurobiological markers over time
relate to changes in suicide risk, or c) theoretically and mechanistically relevant neuroimaging procedures in a
prospective design. Cross-sectional research examining neuroimaging markers of past or current self-injurious
thoughts and behaviors (SITBs) has identified dysfunction in regions associated with emotion regulation,
inhibitory control, and decision-making5,6, namely in cognitive control networks (CCN). On the other hand,
dysfunction has also been observed in regions associated with negative affect and rumination such as limbic
(LN) and default mode (DMN) networks. Despite these cross-sectional findings, identification of neuroimaging
predictors of future suicide attempts, and neural markers of successful suicide risk intervention outcomes
represents a completely novel, critical step to guiding optimal targeting of neurobiologically-informed
interventions and translating neuroimaging of suicide into practice. Whether these potential neuroimaging
predictors are identifiable during resting state, or whether more suicide-relevant cognitive tasks are required,
such as death-related bias or inhibitory control, remains an open yet critical question.
The purpose of our proposed study is to compare two evidence-based suicide risk interventions that
vary in dose in order to a) directly test if a more intensive intervention produces greater risk reduction, b)
identify veterans for whom a more intensive intervention is indicated, and c) identify resting-state and task-
based neurobiological markers of future suicide attempts and examine how changes in these markers relate to
changes in suicide risk over time. We will recruit and evenly randomize 136 male and female veterans
hospitalized for suicide risk to ECRP or BCBT. We will collect neuroimaging data immediately upon discharge,
post-treatment, and 12-months post-discharge and assess SITBs out to 12-months post-discharge.
Public Health Relevance Statement
Veteran suicide prevention has been identified as a national healthcare and research priority2. The aims of this
study are to address three prominent gaps in the scientific literature. We will compare two evidence-based
suicide risk interventions that vary in dose in order to a) directly test if a more intensive intervention produces
greater risk reduction, b) identify veterans for whom a more intensive intervention is indicated, and c) identify
resting-state and task-based neurobiological markers of future suicide attempts and examine how changes in
these markers relate to changes in suicide risk over time. We will recruit and evenly randomize 136 male and
female veterans hospitalized for suicide risk to an efficient or a more time-intensive intervention. We will collect
neuroimaging data immediately upon discharge, post-treatment, and 12-months post-discharge and assess
self-injurious thoughts and behaviors out to 12-months post-discharge.
NIH Spending Category
No NIH Spending Category available.
Project Terms
AddressAfghanistanAftercareBehaviorBeliefBrainCessation of lifeCharacteristicsClinicalCognitionCognitive TherapyDataDecision MakingDoseEmotionalEvidence based interventionFeeling suicidalFemaleFunctional Magnetic Resonance ImagingFunctional disorderFutureHealth CareHospitalizationIndividualInpatientsIntensive CareInterventionIraqLiteratureNeurobiologyOutcomeOutpatientsPatternPrediction of Response to TherapyProceduresRandomizedRecording of previous eventsResearchResearch PriorityResource AllocationResourcesRestRisk FactorsRisk ReductionSamplingSelf AssessmentSuicideSuicide attemptSuicide preventionTestingThinkingTimeTranslatingTreatment outcomeVeteransactive dutycognitive controlcognitive taskcomparative efficacydesignemotion dysregulationemotion regulationevidence baseexperiencefollow-uphigh riskmalenegative affectneuralneurobiological mechanismneuroimagingneuroimaging markernovelpharmacologicpost 9/11preventive interventionprospectivepsychosocialrecruitreducing suicideresponseruminationservice membersuicidal behaviorsuicidal risksuicide ratetreatment as usualtreatment comparison
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