Peer mentorship to reduce suicide attempts among high-risk adults (PREVAIL): Rationale and design of a randomized controlled effectiveness-implementation trial

Abstract

Rationale: Novel approaches to suicide prevention are needed to address increasing rates of suicide deaths. Research suggests that interventions led by certified Peer Specialists may improve suicide protective factors such as hope and connectedness; however, the effectiveness of a Peer Specialist intervention for reducing suicidal thoughts or behaviors has not previously been tested empirically.

Design: We describe the methodology of a randomized controlled hybrid effectiveness-implementation trial of a peer specialist intervention known as PREVAIL (Peers for Valued Living). The primary effectiveness aim is to determine whether the 3-month peer mentorship intervention compared to a minimally enhanced usual care condition reduces suicide attempts and suicidal ideation among adults at high risk for suicide who have been psychiatrically hospitalized. Secondary effectiveness outcomes include medically serious suicide attempts according to chart review and self-reported self-efficacy to avoid suicide. We also describe suicide risk management, supervision, and fidelity monitoring in the context of Peer Specialist providers and our methods for assessing implementation barriers and facilitators.

Conclusion: The PREVAIL trial will demonstrate novel methods for incorporating peer providers into a suicide prevention effectiveness trial with high-risk study participants. PREVAIL's hybrid effectiveness-implementation design aims to maximize the likelihood of rapid implementation in the community if shown to be effective.

Keywords: Hybrid trial; Peer group; Protocol; Suicide prevention.

Fig. 1.

Interpersonal theory of suicide constructs in relationship to peer mentorship.

Fig. 2.

Suicide risk screening and management protocol. Action Step 1: The Peer reviews the participant’s suicide safety plan and ensures the participant has contact information for local mental health services and the telephone number for the National Suicide Prevention Lifeline. Action Step 2: The Peer calls the study’s on-call mental health clinician for further assessment and management with the participant still present. If the on-call provider is not available, the participant will be connected with the National Suicide Prevention Lifeline. The participant’s regular mental health provider will also be notified.

Fig. 3.

Mediation model of intervention effectiveness.