Project Life Force
Article in review: Goodman,M., Brown, G.K., Galfalvy, H.C., Spears,A.P., Sullivan, S., Kapil-Pair, K.N., Jager-Hyman, S., Dixon,L., Thase, M., Stanley, B. (2020). Group (“Project Life Force”) versus Individual Suicide Safety Planning: A Randomized Clinical Trial. Contemporary Clinical Trials Communications, https://doi.org/10.1016/j.conctc.2020.100520
An innovative study is about to get underway in America. The study will trial a group approach for the creation, acceptance and implementation of Suicide Safety Plans for people who are at risk of death by suicide. With a target population of veterans who have had suicide-related hospitalisations, the study will assess if there are benefits to using a novel group-based intervention to develop further the widely accepted evidence-based strategy of suicide safety planning.
Suicide Safety Planning
The use of a Suicide Safety Plan is considered a best practice tool that people who are suicidal can use to outline activities and steps that can be undertaken should feelings of suicidality present. These plans describe specific warning signs, coping strategies and the details of people and services that could be contacted to offer support. The plan’s intent is to both prevent suicidal crises from escalating and discourage the person from acting on a suicidal urge. The plans are often completed by the suicidal individual, with support from a trained professional.
Veterans are known to be at specific suicide risk, and because they are considered acceptable across all demographics, Suicide Safety Plans are often developed to support suicidal veterans. Yet there have been some studies that which question the effectiveness of the Suicide Safety Plan. This article cites previous research in which of the participants who had created Suicide Safety Plans, only 70% were able to identify contacts to call as listed on the plan, and at follow up only 65% had reviewed the plan for relevance within the month prior.
Study participants and approach
Participants will be veterans aged between 18 and 89 years and who have had hospitalisation on an inpatient unit for suicide ideation or attempt. The study’s main aim will be to assess the effectiveness of the creation of the Suicide Safety Plan in a group rather than an individual setting.
The study will involve identifying at-risk veterans to be either supported to develop an individual suicide safety plan or be allocated to develop the Suicide Safety Plan through a group setting. The group sessions would be held weekly for ninety minutes.
The study will test the hypotheses that when compared to individuals using the safety plan, veterans involved in the program would demonstrate a:
- decrease in suicidal behaviour
- decrease in depression and hopelessness
- increased compliance and more positive attitudes to mental health treatment
- increased level of suicide-related coping
Other exploratory aims will be to determine if:
- improved belongingness impacts treatment responses required
- group cohesion partially mediates the need for some treatment responses
- and if these responses were more common in the group setting compared to those who used the Suicide Safety Plan individually.
Group sessions structure
After an introduction, the first six sessions would cover the steps of the safety plan, with subsequent sessions covering other relevant wellbeing and technological content.
The group sessions topics will be:
- Introduction – crisis management skills and urge restriction
- Warning signs – emotion recognition skills
- Internal coping strategies – distress tolerance and coping skills
- Identifying people to help distract – making friends skills
- Sharing safety plans with family – interpersonal skills and asking for help
- Professional contacts – skills to maximize treatment, efficacy and adherence
- Making the environment safe – means restriction and psychoeducation about methods
- Improving access to the safety plan – use of safety planning mobile apps
- Physical health management – skills to maximize physical health and wellbeing
- Building a positive life – building a reason for living
The program will finish with a review and recap of the material, with an optional booster session for participants. Further content is available to be covered should a group member die by suicide.
An extensive number of self-report and interview assessments will be used as evaluation methods in this study. These include the Beck Depression Inventory-II, the Beck Hopelessness Scale, the world Mental Health Composite International Diagnostic Interview, and the Bec Lethality scale) will be completed by all participants. The findings of these assessments will be considered along with a medical record review, and vital statistics registry review. This includes access to information related to all types of suicidal behaviours including suicides, attempts, interrupted attempts, aborted attempts and preparatory behaviours.
This study will provide advancement for treatment in high-risk veteran populations and address gaps in our knowledge and the relevant literature.