Adapting a telehealth intervention for suicide prevention among patients with Alcohol Use Disorder in Tanzania - Globally, alcohol use disorders (AUD) cause 3.3 million deaths each year and account for nearly 100 million disability-adjusted life years (DALYs). Alcohol use is also one of the most prominent risk factors for death by suicide, as people with AUD have a lifetime risk of suicide more than 7 times higher than the general population. Efforts to prevent suicide can reduce disruptions and fragility of the U.S. health system and serve as a public health good to benefit Americans. We are developing innovative approaches to bridge mental health and substance use treatment gaps, including telehealth and nurse-led counseling interventions with clear potential to reduce suicide in the United States and other settings. In our preliminary study, 7% of patients with AUD were experiencing suicidal thoughts or behavior. Despite this high comorbidity, routine screening and treatment for both suicide risk and alcohol use disorder are extremely rare in emergency care settings. Thus, there is a critical need for innovative, resource-efficient treatments for suicide prevention among people with AUD. In an earlier NIMH-funded study, our team adapted an evidence-based Motivational Interviewing intervention, MI-SafeCope, to develop IDEAS for Hope, a telehealth intervention for suicide prevention in HIV care. In the current grant, we will revisit this process by adapting MI-SafeCope to reduce suicide risk among people with AUD who are presenting for care in a Tanzanian Emergency Department. The resulting intervention, IDEAS-AUD, will address suicide risk with a four-pillared approach: reducing alcohol-related harm, building social support, enhancing emotional health, and meeting basic needs. The pillars are integrated with Motivational Interviewing-enhanced safety planning and referral for psychiatric care as appropriate. Intervention refinement in a low-cost, high-burden global setting has great potential for adaptation and implementation in the rural U.S., where mental health needs are high. The aims of this grant are to: 1) adapt IDEAS-AUD for the AUD population; 2) rigorously evaluate the acceptability and feasibility of IDEAS-AUD; and 3) develop our intervention package for a future implementation evaluation and a clinical trial in the rural U.S. In Aim 1 of the current study, we will identify drivers of suicide risk and desired intervention characteristics to prevent suicide in the AUD population. In Aim 2, we will adapt an evidence-based suicide prevention intervention to existing AUD care, guided by a community coalition. In Aim 3, we will pilot test the telehealth intervention to assess its feasibility and acceptability for reducing suicide risk in the AUD population. By the end of this proposed project, we will have a framework-guided, resource-adapted, piloted protocol for IDEAS-AUD, including screening tools, programmatic, and implementation components. The research is innovative, yet fundamentally essential, and supports NIH Strategic Objectives to prevent suicide across the lifespan, address mental health comorbidities such as AUD, and develop interventions that can be rapidly implemented to strengthen mental health outcomes in the U.S. and improve the health of Americans.
