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ORIGINAL RESEARCH article

Front. Psychiatry
Sec. Public Mental Health
Volume 15 - 2024 | doi: 10.3389/fpsyt.2024.1495102
This article is part of the Research Topic Advances in Preventing Suicide Among Veterans View all articles

Mixed-Methods Formative Evaluation of Implementing an Adapted Suicide Prevention Treatment: Dialectical Behavior Therapy Skills Groups in the Veterans Health Administration

Provisionally accepted
Suzanne Decker Suzanne Decker 1,2*Aimee Kroll-Desrosiers Aimee Kroll-Desrosiers 3,4Kristin Mattocks Kristin Mattocks 3,4Frances M Aunon Frances M Aunon 1,2Elizabeth Galliford Elizabeth Galliford 1Neal Doran Neal Doran 5,6Scarlett Baird Scarlett Baird 5,6Jennifer K Rielage Jennifer K Rielage 7,8Josephine Ridley Josephine Ridley 10,9Jenny Bannister Jenny Bannister 11Thorayya S Giovannelli Thorayya S Giovannelli 11Sara J. Landes Sara J. Landes 12,13Marianne Goodman Marianne Goodman 14,15Lorrie Walker Lorrie Walker 3Eric Derycke Eric Derycke 1Chris Shriver Chris Shriver 5Ethan Spana Ethan Spana 7Mark Honsberger Mark Honsberger 9Hannah Brown Hannah Brown 9Stacey Demirelli Stacey Demirelli 11Elena Shest Elena Shest 11Steve Martino Steve Martino 1,2
  • 1 VA Connecticut Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, West Haven, United States
  • 2 Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, United States
  • 3 VA Central Western Massachusetts Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Leeds, Alabama, United States
  • 4 Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States
  • 5 VA San Diego Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, San Diego, California, United States
  • 6 Department Psychiatry, San Diego School of Medicine, University of California, La Jolla, California, United States
  • 7 New Mexico VA Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, Albuquerque, New Mexico, United States
  • 8 Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, United States
  • 9 VA Northeast Ohio Healthcare System, United States Department of Veterans Affairs, Cleveland, Ohio, United States
  • 10 Department of Psychological Sciences, College of Arts and Sciences, Case Western Reserve University, Cleveland, Ohio, United States
  • 11 James A. Haley Veterans’ Hospital, United States Department of Veterans Affairs, Tampa, Florida, United States
  • 12 Behavioral Health Quality Enrichment Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Little Rock, Arkansas, United States
  • 13 Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • 14 Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 2, James J. Peters VA Medical Center, United States Department of Veterans Affairs, Bronx, New York, United States
  • 15 Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States

The final, formatted version of the article will be published soon.

    Background: Preventing veteran suicide requires addressing mechanisms driving suicidal behavior, such as emotion dysregulation. Dialectical Behavior Therapy Skills Groups (DBT-SG) are well established for reducing emotion dysregulation, improving coping skills, and in some studies, reducing suicide attempt, but will require implementation support to deliver DBT-SG and to test its effectiveness within the Veterans Health Administration (VHA). Methods: We conducted a mixed-method developmental formative evaluation of DBT-SG at four VHA medical centers, guided by the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, as part of a hybrid effectiveness-implementation trial (Clinical trials ID Redacted for Blinding). Results: Quantitative Organizational Reasons for Change Assessment data (n = 30 VHA staff) and qualitative data (n = 35 VHA staff) were merged, compared, and triangulated. Quantitative and qualitative data largely converged, showing favorable views of evidence supporting DBT-SG and strong enthusiasm for its potential to reduce veteran suicide attempt. Staff noted DBT-SG’s broad applicability to veterans. Staff were less optimistic about the inner context supporting DBT-SG implementation, commenting on how limited staffing could be a barrier despite leadership wanting to support suicide prevention. Conclusions: Implementation barriers to DBT-SG at VHA include limited staffing, despite staff enthusiasm. The next phase of this project will evaluate DBT-SG effectiveness in a randomized controlled trial.

    Keywords: suicide prevention, Veterans health administration, I-PARIHS, dialectical behavior therapy, Psychotherapy, implementation, mixed methods, Emotion dysregulation

    Received: 12 Sep 2024; Accepted: 29 Oct 2024.

    Copyright: © 2024 Decker, Kroll-Desrosiers, Mattocks, Aunon, Galliford, Doran, Baird, Rielage, Ridley, Bannister, Giovannelli, Landes, Goodman, Walker, Derycke, Shriver, Spana, Honsberger, Brown, Demirelli, Shest and Martino. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Suzanne Decker, VA Connecticut Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, West Haven, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.