Crisis Response Planning for Military Personnel with Mild Traumatic Brain Injury

Aim

Evaluate the efficacy of Crisis Response Planning as a secondary suicide prevention intervention compared with Treatment as Usual among military service members who are at elevated risk for suicide due to their history of mild traumatic brain injury (mTBI).

Research shows that individuals who have been diagnosed with a mild traumatic brain injury, also called mTBI or concussion, are nearly twice as likely to die by suicide as those who have not. This may be due in part to common symptoms of mTBI that overlap with suicide risk factors, including reduced problem-solving ability, difficulty regulating emotions, impulsivity, and feelings of hopelessness, of being a burden to others, and/or of being trapped or stuck in bad situation.

Research also shows that the vast majority of individuals who attempt suicide made the decision to end their life within three hours of their suicide attempt, and over half of military suicide attempts occur on the same day as first onset of suicidal thoughts.

These findings together highlight two important points in the effort to reduce military suicide rates:

  1. If we wait until a service members report suicidal ideation before we intervene, we will miss opportunities to save lives. We need good upstream suicide-prevention strategies with the goal of preventing the onset or progression of suicide risk among patients who do not have a history of suicidal thoughts or behaviors and who are not reporting current suicidal thoughts.
  2. With their heightened risk for suicide, service members seeking treatment for mTBI could potentially benefit greatly from this type of “upstream” prevention strategy.

Researchers develop trial to test an early intervention strategy

With this in mind, STRONG STAR investigators have developed a clinical trial to evaluate Crisis Response Planning (CRP) as a secondary or upstream suicide-prevention tool with service members diagnosed with mTBI. The project is led by led by Principal Investigator (PI) Hannah Tyler, PhD, of The University of Texas Health Science Center at San Antonio and Partnering PI Craig Bryan, PsyD, of The Ohio State University.

CRP is a single-session, evidence-based, suicide-prevention intervention. With CRP, individual patients converse with their therapist and collaboratively develop a crisis response plan – a tangible, easily accessible memory aid and problem-solving tool that aims to help the patient survive a potential future suicide crisis. CRP achieves these goals by promoting emotion-regulation techniques (i.e., self-management skills, social supports, and reasons for living) and problem-solving skills (i.e., clear actions to take when warning signs are present).

This two-arm study will be conducted in collaboration with the Intrepid Spirit Center at C.R. Darnall Army Medical Center on Fort Cavazos, Texas. Half of study participants will receive treatment as usual through the Intrepid Spirit Center, while the other half will have CRP added to their treatment.

What they expect to find

Participants will be assessed at their beginning of the study and at various intervals for three months following. Researchers expect that participants who receive the CRP will report decreased impulsivity, hopelessness, burdensomeness, and entrapment while also reporting increased positive emotional experiences, resulting in decreased risk of suicide.

Results could support CRP utilization as a simple, low-cost, and efficient upstream suicide prevention strategy that targets key suicide risk factors and promotes protective factors, decreasing suicide mortality.

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