Nurse and Peer Led Suicide Prevention in Tajikistan
Trial Snapshot
- Phase
- Not Applicable
- Status
- Enrolling By Invitation
- Enrollment
- 96
- Locations
- 1
- Primary Endpoint
- Columbia Suicide Severity Rating Scale
Study Overview
Brief Summary
The study takes place in Tajikistan, a postwar country in Central Asia, where Dr. Weine, Dr. Pirova, Dr. Bahromov, and other collaborators successfully implemented a D43 research capacity building project and an R21 and R01 on stepped care for women's mental health in primary care. This study also builds on the team's prior research that demonstrated the effectiveness of nurse- and peer-led interventions, identified risk and protective factors for suicide among women, and on the PREVAIL peer-led suicide prevention model. The specific aims for this new project are: Aim 1: Adapt the evidence-based PREVAIL model into a new SUSTAIN nurse- and peer-led suicide prevention model in primary care for women at moderate or high suicide risk in rural and urban Tajikistan using a participatory co-design process (the Transcreation Framework) with multi-level partners. Aim 2: Evaluate a pilot implementation of the SUSTAIN model in primary care among 96 women with moderate to high suicide risk, 48 randomized to SUSTAIN and 48 to an enhanced usual care condition, with both groups followed for 9 months for suicidal ideations or behaviors, mental health outcomes, and mediators. Aim 3: Assess the acceptability, feasibility, appropriateness, potential for scalability and sustainability, programmatic costs, and partnership of SUSTAIN to inform a future hybrid type 2 effectiveness-implementation pragmatic trial.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Prevention
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to 59 Years (Adult)
- Sex
- Female
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Tajik women age 18 to 59 who meet operationally defined criteria for moderate or high risk suicide risk. We will identify women at-risk for suicide defined as:
- •a recent suicide attempt (past 3 months)
- •recent suicidal ideation that is accompanied by either a plan or intention as assessed by the Columbia-Suicide Severity Rating Scale (C-SSRS). If they score a level 2 or higher on the C-SSRS, they are eligible. Level 2 refers to non-specific active suicidal thoughts. At level 2, a person has general, active thoughts of wanting to end their life but has not formulated a specific plan, method, or intention to act on them.
- •Other inclusion criteria are: 1) willing to participate in the SUSTAIN intervention and research procedures; and 2) able to give written informed consent.
Exclusion Criteria
- •If they score less than a level 2 on the C-SSRS they are not eligible
Arms & Interventions
SUSTAIN intervention
Women in the 6 intervention clinics will be enrolled in the SUSTAIN intervention. This includes nurse and peer co-lead individual, group and family sessions. There are 9 sessions that are attended by the women (6 individual and 3 group) and 1 session that is attended by their family members; this will occur over the course of 8-12 weeks depending on timing and scheduling.
The SUSTAIN Model consists of:
- Six individual sessions for women at-risk of suicide (once a week for 1-1.5 hours)
- Three group sessions for women at-risk of suicide (once a week for 2 hours)
- One education group session for families of women at-risk of suicide (note, the women do not attend this session)
Intervention: Suicide prevention treatment (Behavioral)
Enhanced Care as Usual
In the 6 clinics assigned to the control condition, the women who screen positive for moderate to high suicide risk will receive enhanced usual care. They will be evaluated by a family medicine doctor who will confirm their level of risk and decide on appropriate actions. This could include an admission to inpatient psychiatry, a referral to outpatient psychiatry, or management in the family medicine clinic which may include counseling, psychiatric medication, a family meeting, or a home visit. At the very least, the family medicine doctor will provide them with a list of local crisis support resources.
Intervention: Care as usual (Behavioral)
Outcomes
Primary Outcomes
Columbia Suicide Severity Rating Scale
Time Frame: Baseline and 3, 6, 9 months post intervention
Suicide attempts (measured by the Columbia Suicide Severity Rating Scale) Any suicide attempt as measured according to an electronic self-report version of the Columbia Suicide Severity Rating Scale (CSSR-S). The definition of suicide attempt for the primary outcome will consist of any actual suicide attempt, aborted suicide attempt, or interrupted suicide attempt according to the CSSR-S.
Secondary Outcomes
- Medically serious suicide attempts(3, 6, and 9 months post intervention)
- Suicide Cognitions Scale-Short Form (SCS-S)(3, 6, and 9 month post intervention)
- Beck Hopelessness Scale (BHS)(3, 6, 9 months post intervention)
- Abuse Assessment Screen(3, 6, 9 month post intervention)
- Brief Reasons for Living (BRFL)(3, 6, 9 month post intervention)
- Patient Health Questionnaire-9 (PHQ-9)(3, 6, 9 month post intervention)
- Generalized Anxiety Disorder-7 (GAD-7)(3, 6, 9 months post intervention)
- PTSD CheckList - Civilian Version (PCL-C)(3, 6, 9 months post intervention)
- Pearlin Mastery Scale(3, 6, 9 months post intervention)
- Mental Health Knowledge Schedule (MAKS)(3, 6, 9 months post intervention)
- Short Form Health Survey (SF-12)(3, 6, 9 months post intervention)
- Interpersonal Needs Questionnaire (INQ)(3, 6, 9 months post intervention)