Telehealth Suicide Prevention Program Safe, Acceptable

Pauline Anderson

April 18, 2023

WASHINGTON — A group therapy suicide prevention program for veterans delivered via telehealth is feasible and acceptable, new research shows.

Sarah Sullivan

Skeptics had worried that participating in the program through telehealth would exacerbate safety and other issues veterans had about discussing suicide in a group setting, study investigator Sarah Sullivan, PhD student, Health Psychology & Clinical Science, City University of New York, told Medscape Medical News.

"But that for us was not really true. People opened up about their suicidal thoughts and triggers even on this telehealth format and that's really important for providers to know."

The findings were presented here at the Anxiety and Depression Association of America (ADAA) meeting.

Trial Run

Suicide is a major public health issue, particularly for veterans. Recent data from the Veterans Administration (VA) show 17 veterans die by suicide every day.

The current study included 15 male and 2 female veterans (29.4% White, 70.6% Hispanic) from New York City and Philadelphia. Participants had an average age of 50 and all were either deemed by a clinician to be at extremely high risk for suicide or were hospitalized for this reason.

The individuals completed an online version of the Project Life Force (PLF) program, which uses dialectical behavioral therapy (DBT) and psychoeducational approaches. The program includes the brief Safety Planning intervention (SPI), aimed at reducing short-term suicide risk.

Considered a best practice, the SPI includes a written list of personal suicide warning signs or triggers, internal coping strategies, social contacts who offer support and distraction from suicidal thoughts, contact information for professionals, a suicide crisis hotline, and nearby emergency services.

In addition to these steps, the PLF program focuses on sleep, exercise, and making the safety plan accessible.

The telehealth platform for the program was WebEx software. Participants were offered a "trial run" to orient them to the technology, said Sullivan.

Group sessions were held once weekly for 10 weeks, with optional "booster" sessions if needed. Each session included about five participants.

To ensure privacy, participants were provided with headphones and laptops. This was important especially for those sharing a living space, including spouses and children, said Sullivan.

High Ratings

Participants completed the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). Each of these yields scores from four items rated on a Likert scale of 1-5, for a total score ranging from 5 to 20, with higher scores indicating higher ratings.

Veterans rated PLF-T as highly acceptable (mean AIM 17.50), appropriate (mean IAM 17.25), and feasible (mean FIM 18).

Study participants reported the program was convenient and noted that it decreased the burden of traveling to sessions, especially during the COVID-19 pandemic.

They also reported the program was less likely to compete with other demands such as childcare and other appointments, said Sullivan.

In addition, it helped those with comorbidities such as posttraumatic stress disorder, she added. She noted veterans with PTSD may be triggered on subways or buses when traveling to in-person treatment sessions.

"That can take away from addressing the suicidal triggers," said Sullivan. "So, this program allows them to fully concentrate on the safety plan."

Results showed study participants "enjoyed the group and would recommend it to others," said Sullivan. "I think that signifies the group was effective in its goal of mitigating loneliness, which was exacerbated during the COVID-19 pandemic, and creating a socially supportive environment, especially for the vets living alone."

Veterans also reported that the program helped them understand the connection between depression or PTSD and suicidal thoughts, urges, and plans. In addition, they appreciated the group dynamics where they felt connected to other veterans experiencing similar challenges.

Hopeful Results

Commenting for Medscape Medical News, Paul E. Holtzheimer, MD, deputy director for research at the National Center for PTSD, praised the study for focusing on a very high-risk group.

"This gets you closer to the population you're probably going to have an impact on in terms of preventing suicide," said Holtzheimer, a  professor of psychiatry and surgery at Dartmouth College's Geisel School of Medicine, Hanover, New Hampshire.

The fact that many of the participants had attempted suicide in the last year underlines that this was a very high-risk population, said Holtzheimer. "Not only are they thinking about suicide but almost two thirds had actually attempted or tried something."

This kind of program "would be great for rural environments where people may be living like four hours away from the VA or a clinic," said Holtzheimer noting that many veterans are often quite isolated.

"One of the very positive outcomes of the COVID-19 pandemic was helping us strengthen our ability to do telehealth," he said.

However, Holtzheimer noted the study was small and qualitative. "The next step ideally would be a controlled trial looking at not just ideation but at risky behavior or clear suicide attempts or preparation like buying a gun or hoarding medication, to help determine efficacy."

The researchers and Holtzheimer report no relevant financial relationships.

Anxiety and Depression Association of America (ADAA) Conference 2022. Presented April 14, 2023.

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