James J. Peters VA Medical Center, Bronx, NY, USA.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Altern Complement Med. 2021 Mar;27(S1):S14-S27. doi: 10.1089/acm.2020.0245.
Suicide is a major public health problem, specifically among U.S. veterans, who do not consistently engage in mental health services, often citing stigma as a barrier. Complementary and Integrative Health (CIH) interventions are promising alternatives in promoting patient engagement and further, they may play a critical role in transitioning people into mental health care. Toward this goal, the Resilience and Wellness Center (RWC) was developed to break through the stigma barrier by addressing risk factors of suicide through multimodal CIH interventions via cohort design, promoting social connectedness and accountability among participants. This is a program evaluation study at a large urban VA medical center, where assessments were evaluated from pre- to post-program completion to determine the effectiveness of an intensive multimodal CIH 4-week group outpatient intervention for suicide prevention. Primary outcomes measured included group connectedness, severity of depression and hopelessness symptoms, suicidal ideation, sleep quality, and diet. Secondary outcomes included measures of post-traumatic stress disorder (PTSD), generalized anxiety severity stress/coping skills, pain, and fatigue. The RWC showed high participant engagement, with an 84%-95% attendance engagement rate depending on suicide risk history. Data from 15 cohorts ( = 126) demonstrate favorable outcomes associated with participation in this comprehensive program, as evidenced by a reduction in suicidal ideation, depression, and hopelessness, but not sleep quality and diet. In addition, in a subset of veterans with a history of suicidal ideation or attempt, significant improvements were noted in pain, PTSD/anxiety symptoms, and stress coping measures. The RWC shows that an intensive complement of CIH interventions is associated with a significant improvement with high veteran engagement. Findings from this program evaluation study can be used to aid health care systems and their providers in determining whether or not to utilize such multimodal CIH integrated interventions as an effective treatment for at-risk populations as a part of suicide prevention efforts.
自杀是一个重大的公共卫生问题，尤其是在美国退伍军人中，他们并没有持续接受心理健康服务，经常将耻辱感作为一个障碍。补充和综合健康（CIH）干预措施是促进患者参与的有希望的替代方法，此外，它们可能在将人们过渡到心理健康护理方面发挥关键作用。为此，Resilience and Wellness Center（RWC）通过多模态 CIH 干预措施通过队列设计来解决自杀风险因素，通过促进参与者之间的社交联系和责任感，旨在打破耻辱感的障碍。这是一家大型城市退伍军人事务医疗中心的计划评估研究，在该研究中，从计划开始前到完成后评估评估结果，以确定密集的多模式 CIH 4 周小组门诊干预措施预防自杀的有效性。主要测量结果包括小组联系、抑郁和绝望症状严重程度、自杀意念、睡眠质量和饮食。次要结果包括创伤后应激障碍（PTSD）、广泛性焦虑严重程度压力/应对技能、疼痛和疲劳的测量。RWC 显示出高度的参与者参与度，根据自杀风险史，出勤率参与率为 84%-95%。来自 15 个队列（=126）的数据表明，与参与这一综合计划相关的结果良好，因为自杀意念、抑郁和绝望感有所减少，但睡眠质量和饮食没有变化。此外，在有自杀意念或企图史的退伍军人亚组中，疼痛、PTSD/焦虑症状和应激应对措施显著改善。RWC 表明，密集的 CIH 干预措施与高退伍军人参与度相关，可显著改善。该计划评估研究的结果可用于帮助医疗保健系统及其提供者确定是否使用这种多模态 CIH 综合干预措施作为高危人群的有效治疗方法，作为预防自杀工作的一部分。
