Suicide and attempted suicide are major public health issues in the U.S., accounting for almost 45,000 deaths
in 2016, and over 1 million attempts each year. There is an urgent need for interventions based on evidence-
based principles that decrease suicidal behavior and are feasible to deliver to large numbers of patients at
times when their risk for suicide is high. In this treatment development project, we propose to develop and test
a narrative-based video intervention for people with suicidal behavior or plan being discharged from psychiatric
hospitalization. In response to the need for treatment over this transition, we previously developed a 6-month,
in-person and telephone, clinician-delivered, psychosocial intervention called Coping Long Term with Active
Suicide Program (CLASP) for patients being discharged from psychiatric hospitalization. CLASP targets key
risk factors associated with suicidal behavior in order to reduce subsequent risk. In this project, we propose to
develop a new intervention, called LifePlans, based on the CLASP model but using an easily disseminable
video-based format in which real patients discuss their history of suicidal behavior and coping strategies.
Based on previous research, we believe that having people with lived experience tell their own stories has the
potential to be engaging and to catalyze behavior change. LifePlans will consist of 5, 30-min episodes that
highlight patients’ experiences consistent with the CLASP model: 1) developing a personalized “Life Plan” to
stay safe and restrict means, 2) clarifying valued life domains and related goals to improve hopefulness, 3)
using problem solving to cope with illness, 4) improving communication with family/friends to increase social
support, and 5) adhering to outpatient treatments. This study will have 3 phases. In phase 1, we will interview
patients with a history of psychiatric hospitalization for suicidal behavior about their life experiences and coping
history. We will invite a subset back to be interviewed on camera for a series of documentary-style videos that
will form the basis of LifePlans. After the filming of additional clinician-related content and with feedback from a
Patient and Family Advisory Council, we will create 5, 30-min episodes of LifePlans and accompanying patient
workbook that illustrate key CLASP principles using narrative methods. We will then conduct an open trial
(n=10; phase 2) and a pilot RCT (n=40; phase 3) to test the feasibility/acceptability of LifePlans for hospitalized
patients with a pre-admission suicide plan/attempt. Patients will be assessed at baseline, discharge, 1, and 6
months post-discharge on suicidal behaviors (primary), suicidal ideation, psychiatric symptoms, functioning,
rehospitalization rate, and possible mechanisms. We will examine feasibility and acceptability (rate of video
viewing, engagement, satisfaction, recruitment/retention). In the RCT, we will examine treatment differences
(within relevant confidence intervals) on outcomes (e.g., suicide behaviors), and change on possible
mechanisms. Ultimately, this project will provide the data needed to test LifePlans in a full-scale RCT to
determine its effectiveness and mechanisms of action for suicide prevention in high-risk patients.
