Suicide Intervention for Alaska Native Youth (BeWel)

Comparative Effectiveness of Two Culturally-Centered Suicide Interventions for Alaska Native Youth

Two interventions will be delivered virtually to American Indian/Alaska Native youth who have been hospitalized with suicidal attempt, suicidal ideation, or associated risk behaviors, including alcohol-related injury.

Study Overview

• Status: Recruiting
• Conditions: Suicidal Ideation; Suicide, Attempted; Alcohol Intoxication; Alaska Native Youth Aged 14 - 24
• Intervention / Treatment: Behavioral: Tools for Life; Behavioral: Tools for Life + MISN

Detailed Description

The investigators will conduct a randomized controlled trial whereby Alaska Native (AN) youth who are hospitalized for suicide risk will be randomly assigned to either Qungasvik/Tools for Life or Tools for Life + Motivational Interviewing Social Network (MISN) intervention after their baseline survey, and followed up at 3-, 6-, and 12 months. All youth will receive Tools for Life and two 30-minute virtual follow-up visits (at 2- and 6-weeks post intervention) focused on connectivity to culture and obtaining support from intergenerational social networks in their home communities. Half of the youth will also receive MISN in addition to Tools for Life. Both interventions will be delivered virtually by a wellness team comprised of Alaska Native community behavioral health aides, prevention specialists and/or Elders who function in their communities as natural healers.

• Study Type: Interventional
• Enrollment (Estimated): 370
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Elizabeth J D'Amico, PhD; Phone Number: 6487 3103930411; Email: damico@rand.org
• Study Contact Backup: Name: Stacy Rasmus, PhD; Phone Number: 907-474-7352; Email: smrasmus@alaska.edu

Study Locations

• United States
  • Alaska
    • Bethel, Alaska, United States, 99559
      • Recruiting
      • Yukon-Kuskokwim Health Corporation
      • Contact: Cynthia Nation
    • Fairbanks, Alaska, United States, 99559
      • Recruiting
      • Tanana Chiefs Conference
      • Contact: Cynthia Nation

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 15 years to 24 years (Child, Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Self-identify as Alaska Native youth
• Between the ages of 14 and 24
• Admitted to the hospital for suicide attempt, ideation, or associated risk behaviors including alcohol-related injury or acute intoxication

Exclusion Criteria:

-

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Tools for Life; All youth will receive the Tools for Life (Qungasvik) intervention. Tools for Life is an evidence-based, community-developed intervention focused on providing protective cultural experiences for Alaska Native youth to address suicide risk and alcohol use.	Behavioral: Tools for Life; Tools for Life focuses on empowering youth to learn more about their culture and their identity.
Active Comparator: Tools for Life + Motivational Interviewing Social Network intervention (MISN); Half of the youth will will also receive MISN in addition to the Tools for Life intervention. MISN is an evidence-based treatment that augments motivational interviewing with personal social network composition and structure visualization as a means to cultivating healthy social networks and cultural worlds.	Behavioral: Tools for Life + MISN; Tools for Life focuses on empowering youth to learn more about their culture and their identity. MISN focuses on helping youth get support from their community and social networks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Suicide intent/risk	We will use the Suicidal Ideation Attributes Scale (SIDAS) [0 = Never, 10 = Always]	Change from baseline to 3 months
Suicide intent/risk	We will use the Suicidal Ideation Attributes Scale (SIDAS) [0 = Never, 10 = Always]	Change from baseline to 6 months
Suicide intent/risk	We will use the Suicidal Ideation Attributes Scale (SIDAS) [0 = Never, 10 = Always]	Change from baseline to 12 months
Depression	Patient Health Questionnaire (PHQ-9) [0 -not at all to 3-nearly every day]	Change from baseline to 3 months
Depression	Patient Health Questionnaire (PHQ-9) [0 -not at all to 3-nearly every day]	Change from baseline to 6 months
Depression	Patient Health Questionnaire (PHQ-9) [0 -not at all to 3-nearly every day]	Change from baseline to 12 months
Anxiety	Generalized Anxiety Disorder scale (GAD-7) [0 -not at all to 3-nearly every day]	Change from baseline to 3 months
Anxiety	Generalized Anxiety Disorder scale (GAD-7) [0 -not at all to 3-nearly every day]	Change from baseline to 6 months
Anxiety	Generalized Anxiety Disorder scale (GAD-7) [0 -not at all to 3-nearly every day]	Change from baseline to 12 months
Frequency of alcohol use	Number of days used in the past 30 days. [ 0 to 30]	Change from baseline to 3 months
Frequency of alcohol use	Number of days used in the past 30 days [ 0 to 30]	Change from baseline to 6 months
Frequency of alcohol use	Number of days used in the past 30 days [ 0 to 30]	Change from baseline to 12 months
Alcohol use consequences	Number of times in the past 3 months youth experience 4 different alcohol consequences [0 = Never to 6 = 20 or more times]	Change from baseline to 3 months
Alcohol use consequences	Number of times in the past 3 months youth experience 4 different alcohol consequences [0 = Never to 6 = 20 or more times]	Change from baseline to 6 months
Alcohol use consequences	Number of times in the past 3 months youth experience 4 different alcohol consequences [0 = Never to 6 = 20 or more times]	Change from baseline to 12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Sobriety self-efficacy	Three items ask how sure youth are about staying sober from alcohol from 1= def drink to 5 = def not drink	Change from baseline to 3 months
Sobriety self-efficacy	Three items ask how sure youth are about staying sober from alcohol from 1= def drink to 5 = def not drink	Change from baseline to 6 months
Sobriety self-efficacy	Three items ask how sure youth are about staying sober from alcohol from 1= def drink to 5 = def not drink	Change from baseline to 12 months
Intentions to be sober from alcohol	Youth report on intentions to be sober in the next 6 months from 1 = def yes to 4 = def no	Change from baseline to 3 months
Intentions to be sober from alcohol	Youth report on intentions to be sober in the next 6 months from 1 = def yes to 4 = def no	Change from baseline to 6 months
Intentions to be sober from alcohol	Youth report on intentions to be sober in the next 6 months from 1 = def yes to 4 = def no	Change from baseline to 12 months
Social network composition	Participants will be asked to name 15 contacts ("alters") who are at least 18 years of age. Participants will rate each of the 15 people on the same set of questions with categorical response options (about demographics, relationship quality, likelihood to use drugs, etc.). For each participant, the selected responses will be summed across all of the network alters and divided by 15 to produce network composition percentages of the whole set of alters named by the participant (% of AI/ANs, % who engage in heavy drinking).	Change from baseline to 3 months
Social network composition	Participants will be asked to name 15 contacts ("alters") who are at least 18 years of age. Participants will rate each of the 15 people on the same set of questions with categorical response options (about demographics, relationship quality, likelihood to use drugs, etc.). For each participant, the selected responses will be summed across all of the network alters and divided by 15 to produce network composition percentages of the whole set of alters named by the participant (% of AI/ANs, % who engage in heavy drinking).	Change from baseline to 6 months
Social network composition	Participants will be asked to name 15 contacts ("alters") who are at least 18 years of age. Participants will rate each of the 15 people on the same set of questions with categorical response options (about demographics, relationship quality, likelihood to use drugs, etc.). For each participant, the selected responses will be summed across all of the network alters and divided by 15 to produce network composition percentages of the whole set of alters named by the participant (% of AI/ANs, % who engage in heavy drinking).	Change from baseline to 12 months
Social network structure	Participants will rate the relationship strength between each of the 15 named alters. For each alter pair participants will rate if the two people know each other and, if yes, have individuals connected recently. Measures of network structure (i.e., network "connectedness") will be constructed from the set of evaluations for each participant. For example, network "density" will be constructed for the network overall, which is calculated by summing the number of alter pairs who know each other and dividing by the total number of possible ties among 15 alters (105). Individual alter "centrality" will be calculated by summing the number of connections each individual alter has with other alters in the network.	Change from baseline to 3 months
Social network structure	Participants will rate the relationship strength between each of the 15 named alters. For each alter pair participants will rate if the two people know each other and, if yes, have individuals connected recently. Measures of network structure (i.e., network "connectedness") will be constructed from the set of evaluations for each participant. For example, network "density" will be constructed for the network overall, which is calculated by summing the number of alter pairs who know each other and dividing by the total number of possible ties among 15 alters (105). Individual alter "centrality" will be calculated by summing the number of connections each individual alter has with other alters in the network.	Change from baseline to 6 months
Social network structure	Participants will rate the relationship strength between each of the 15 named alters. For each alter pair participants will rate if the two people know each other and, if yes, have individuals connected recently. Measures of network structure (i.e., network "connectedness") will be constructed from the set of evaluations for each participant. For example, network "density" will be constructed for the network overall, which is calculated by summing the number of alter pairs who know each other and dividing by the total number of possible ties among 15 alters (105). Individual alter "centrality" will be calculated by summing the number of connections each individual alter has with other alters in the network.	Change from baseline to 12 months
Time spent around peers who use alcohol	Participants will report on how much time is spent around peers who drink from 0 = never to 3 = often	Change from baseline to 3 months
Time spent around peers who use alcohol	Participants will report on how much time is spent around peers who drink from 0 = never to 3 = often	Change from baseline to 6 months
Time spent around peers who use alcohol	Participants will report on how much time is spent around peers who drink from 0 = never to 3 = often	Change from baseline to 12 months
Awareness of connectedness	Youth report on feelings of connectedness to community, family and environment from 1 = strongly agree to 5 strongly disagree	Change from baseline to 3 months
Awareness of connectedness	Youth report on feelings of connectedness to community, family and environment from 1 = strongly agree to 5 strongly disagree	Change from baseline to 6 months
Awareness of connectedness	Youth report on feelings of connectedness to community, family and environment from 1 = strongly agree to 5 strongly disagree	Change from baseline to 12 months
Community protective factors	Youth Community Protective Factors Scale. Youth report on feelings about different protective factors from 1 = strongly agree to 5 strongly disagree	Change from baseline to 3 months
Community protective factors	Youth Community Protective Factors Scale Youth report on feelings about different community protective factors from 1 = strongly agree to 5 strongly disagree	Change from baseline to 6 months
Community protective factors	Youth Community Protective Factors Scale Youth report on feelings about different community protective factors from 1 = strongly agree to 5 strongly disagree	Change from baseline to 12 months
Individual protective factors	Youth report on feelings about different individual protective factors from 1 = strongly agree to 5 strongly disagree	Change from baseline to 3 months
Individual protective factors	Youth report on feelings about different individual protective factors from 1 = strongly agree to 5 strongly disagree	Change from baseline to 6 months
Individual protective factors	Youth report on feelings about different individual protective factors from 1 = strongly agree to 5 strongly disagree	Change from baseline to 12 months
Reasons for life	Brief Reasons for Life Scale from 1 not at all important to 5 very important	Change from baseline to 3 months
Reasons for life	Brief Reasons for Life Scale from 1 not at all important to 5 very important	Change from baseline to 6 months
Reasons for life	Brief Reasons for Life Scale from 1 not at all important to 5 very important	Change from baseline to 12 months
Reflective processes	The Reflective Processes scale taps a culturally patterned type of awareness and youth report from from 1 = strongly agree to 5 strongly disagree	Change from baseline to 3 months
Reflective processes	The Reflective Processes scale taps a culturally patterned type of awareness and youth report from from 1 = strongly agree to 5 strongly disagree	Change from baseline to 6 months
Reflective processes	The Reflective Processes scale taps a culturally patterned type of awareness and youth report from from 1 = strongly agree to 5 strongly disagree	Change from baseline to 12 months

Collaborators and Investigators

• Sponsor: RAND
• Collaborators: Patient-Centered Outcomes Research Institute

Study record dates

Study Major Dates

• Study Start (Actual): December 22, 2022
• Primary Completion (Estimated): March 1, 2026
• Study Completion (Estimated): May 1, 2026

Study Registration Dates

• First Submitted: April 29, 2022
• First Submitted That Met QC Criteria: April 29, 2022
• First Posted (Actual): May 4, 2022

Study Record Updates

• Last Update Posted (Actual): February 16, 2024
• Last Update Submitted That Met QC Criteria: February 13, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: Alaska Native youth, suicide, prevention, culture
• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Chemically-Induced Disorders; Alcohol-Related Disorders; Substance-Related Disorders; Self-Injurious Behavior; Suicide; Suicidal Ideation; Suicide, Attempted; Alcoholic Intoxication
• Other Study ID Numbers: YY46Q97AEZA8

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The investigators will share only deidentified, aggregate data.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No