Reducing suicide risk among aging caregivers of persons with AD/ADRD: Adapting, implementing, and evaluating Dialectical Behavior Therapy skills training interventions. - ABSTRACT Informal caregivers (ICs; non-professional caregivers) of persons with Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD) experience caregiving-related distress and have about 650% higher rates of suicide ideation (SI; 32.32%) compared to the general population (4.3%). Dialectical Behavior Therapy (DBT), an evidence-based intervention for suicide, addresses multiple areas of psychosocial functioning. Standard DBT is often too resource-intensive (6 months to 1 year of weekly individual sessions and 1.5-2.5- hour weekly skills training group sessions) and is not tailored to ICs of persons with AD/ADRD with SI, creating a significant barrier to SI treatment. We will develop, implement, and evaluate an adapted DBT skills training groups tailored to the unique experiences and needs of ICs of persons with AD/ADRD to reduce suicide-re- lated outcomes most effectively. Our specific aims are: (1) Adapt DBT skills groups for ICs (of persons with AD/ADRD) endorsing direct or indirect SI (directly stated SI vs. indirect indicators of SI) to ensure it applies to direct and indirect SI and considers SI underreporting; (2) Evaluate the feasibility, acceptability, and fidelity of the adapted DBT skills groups in this sample; (3) Assess preliminary effectiveness indicators of the adapted DBT skills groups. For Aim 1, a panel of experts and two stakeholders (Garrison Institute of Aging (GIA) staff; IC of a person with AD/ADRD), will inform the adaptation of DBT skills training to ICs of persons with AD/ADRD and shorten to 16 weekly, 1-hour skills groups sessions, over 4 months. For Aims 2 and 3, we will implement the adapted DBT skills training groups among ICs of persons with AD/ADRD with direct/indirect SI at screening while providing respite, all at GIA. We will collect relevant demographic data from ICs and IC-re- ported data about the person with AD/ADRD. Over 18 time points (baseline, following weekly DBT sessions, follow-up), participants will complete self-report assessments targeting DBT fidelity/acceptably, SI (direct and indirect), and suicide risk correlates. We will also record DBT session to monitor fidelity. We will track partici- pant recruitment, group attendance, retention as feasibility metrics. We will also use innovative methodology by collecting inflammation biomarkers and heart rate variability data as an indirect SI assessment. Lastly, we will conduct IC focus groups after the intervention for additional qualitative acceptability and feasibility data. We will also survey GIA site staff to evaluate their perceived acceptability and feasibility of the intervention at GIA. Our hypotheses are that 1) our adapted DBT skills group will be feasible, acceptable, and maintain DBT fidelity, and 2) SI (direct and indirect), suicide risk factors, and inflammation will decrease, and heart rate variability will increase post intervention. Our expected outcomes are to have a scalable DBT group intervention for ICs of persons with ADRD, indications of feasibility and acceptability, and preliminary effectiveness indicators. This work will provide a life-saving suicide prevention approach for ICs of persons with AD/ADRD, provide students with multidisciplinary research experiences, and significantly strengthen our university research environment.
