An interventional study of BESST and Standard Mental Health Care in Suicide Prevention, sponsored by White River Junction Veterans Affairs Medical Center. Completed at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-09-05.
Sponsored by White River Junction Veterans Affairs Medical Center · Not applicable, Interventional, and Prevention
The goal of this pilot randomized controlled trial is to test an adapted suicide prevention program (the Building VA Engagement, Self-efficacy, and Social Support To Prevent Suicide or BESST) in rural Veterans discharged from community care mental health treatment settings. The main question it aims to answer is:
Participants will be assigned by change to a treatment group. Some will receive the BESST intervention combined with standard care, and some will receive standard care alone. All participants will be in this research study for up to three months.
Those receiving the BESST intervention will have:
All participants will have three assessment interviews where they will be asked about their mental health and treatment received outside of the VA.
The investigators will compare participants assigned to the BESST intervention combined with standard care vs participants assigned to standard care alone to see if the BESST intervention improves suicide-related outcomes.
Exclusion Criteria:
Patients randomized to the BESST intervention arm will receive the BESST intervention combined with standard mental health care.
Behavioral: BESST · Other: Standard Mental Health Care
Patients randomized to the control arm will receive standard mental health care alone.
Other: Standard Mental Health Care
The BESST intervention is a suicide prevention program designed to meet the unique needs of Veterans receiving care from community mental health treatment settings. BESST can be delivered by a trained mental health staff member, such as a mental health nurse, social worker, psychologist, or psychiatrist. The intervention consists of two synergistic components that work to support the patient after a mental health-related discharge in community settings: 1) Brief educational session, where the patient receives a one-hour, one-on-one, personalized educational session on suicide prevention; 2) Seven regular contacts after discharge, where the study interventionist who delivered the brief educational visit will contact the patient to monitor the patient's symptoms, assess treatment adherence, review their safety plan, and assist the patient with engaging in care, if needed.
Patients randomized to the control arm will receive standard mental health care alone. Standard mental health care simply refers to the regular care provided to patients around the time of discharge from community care settings.
Also known as: Standard Care
Suicidal Ideation: The Beck Scale for Suicidal Ideation (BSS)
The Beck Scale for Suicidal Ideation (BSS) ranges from 0-38. While there is no established BSS cutoff score to classify suicide risk, there is evidence that higher scores on the BSS correspond to more severe suicidal ideation and that a change of five points or more on the total BSS scores may be clinically relevant.
Time frame: 3 months post-baseline
Hopelessness: Beck Hopelessness Scale (BHS)
The Beck Hopelessness Scale (BHS) is a 20-item self-report scale that assesses hopelessness over the past seven days. Patients report on feelings about the future, loss of motivation, and future expectations. Total scores range from 0 to 20, with higher scores suggesting more hopelessness. The BHS has good reliability and validity and is sensitive to change. There is some evidence that the BHS may be a measure of risk of suicide.
Time frame: 3 months post-baseline
Connectedness: Interpersonal Needs Questionnaire-15 (INQ-15) Perceived Burdensomeness
The Interpersonal Needs Questionnaire-15 (INQ-15) is a 15-item self-report scale that measures thwarted belongingness (9 items) and perceived burdensomeness (6 items). Each item is measured on a 7-point Likert scale, with higher scores suggesting lower perceived connectedness. The score range for the entire scale is 15-105, with the score range for perceived burdensomeness being 6-42.
Time frame: 3 months post-baseline
Connectedness: Interpersonal Needs Questionnaire-15 (INQ-15) Thwarted Belongingness
The Interpersonal Needs Questionnaire-15 (INQ-15) is a 15-item self-report scale that measures thwarted belongingness (9 items) and perceived burdensomeness (6 items). Each item is measured on a 7-point Likert scale, with higher scores suggesting lower perceived connectedness. The score range for the entire scale is 15-105, with the score range for thwarted belongingness being 7-63.
Time frame: 3 months post-baseline
Patient Engagement: General Self-Efficacy Scale (GSES)
The General Self-Efficacy Scale (GSES) is a valid scale of self-efficacy that is designed for the general population (12 years or older) and it has been tested in various countries. It is a 10-item psychometric scale that is designed to assess optimistic self-beliefs to cope with a variety of difficult demands in life. Total scores range from 10 to 40, with higher scores suggesting increased self-efficacy.
Time frame: 3 months post-baseline
Patient Engagement: Suicide-Related Coping Scale (SRCS) External Coping Subscale
The Suicide-Related Coping Scale (SRCS) includes 17 questions related to a patient's perception of their ability to cope with suicidal thoughts. Each item is assessed using a 5-point Likert scale. The scale includes two subscales including an External Coping subscale and an Internal Coping Subscale. The score range for the entire scale is 0-68 with the External Coping being 0-28 and the Internal Coping being 0-28. Higher scores indicate increased perception of suicide-related coping.
Time frame: 3 months post-baseline
Patient Engagement: Suicide Related Coping Scale (SRCS) Internal Coping Subscale
The Suicide-Related Coping Scale (SRCS) includes 17 questions related to a patient's perception of their ability to cope with suicidal thoughts. Each item is assessed using a 5-point Likert scale. The scale includes two subscales including an External Coping subscale and an Internal Coping Subscale. The score range for the entire scale is 0-68 with the External Coping being 0-28 and the Internal Coping being 0-28. Higher scores indicate increased perception of suicide-related coping.
Time frame: 3 months post-baseline
Number of Participants With Suicide Attempts
Suicide attempts is measured using the seven-item subscale on the Columbia-Suicide Severity Rating Scale (C-SSRS), a valid and reliable scale that asks patients to self-report on suicide attempts.
Time frame: 3 months post-baseline
Number of Participants With Substance Use at 3 Months Post-baseline
The investigators will assess substance use at follow-up assessments using a timeline follow-back approach. This method is commonly used in research studies to assess substance use patterns. Numerical scores do not apply to this assessment.
Time frame: 3 months post-baseline
| Milestone | BESST | Control |
|---|---|---|
| Started | 10 | 10 |
| Completed | 10 | 10 |
| Not completed | 0 | 0 |
The Beck Scale for Suicidal Ideation (BSS) ranges from 0-38. While there is no established BSS cutoff score to classify suicide risk, there is evidence that higher scores on the BSS correspond to more severe suicidal ideation and that a change of five points or more on the total BSS scores may be clinically relevant.
| units on a scale | BESST | Control |
|---|---|---|
| Suicidal Ideation: The Beck Scale for Suicidal Ideation (BSS) | 2.0 ± 4.22 | 10.7 ± 9.48 |
The Beck Hopelessness Scale (BHS) is a 20-item self-report scale that assesses hopelessness over the past seven days. Patients report on feelings about the future, loss of motivation, and future expectations. Total scores range from 0 to 20, with higher scores suggesting more hopelessness. The BHS has good reliability and validity and is sensitive to change. There is some evidence that the BHS may be a measure of risk of suicide.
| units on a scale | BESST | Control |
|---|---|---|
| Hopelessness: Beck Hopelessness Scale (BHS) | 5.6 ± 4.74 | 10.4 ± 6.50 |
The Interpersonal Needs Questionnaire-15 (INQ-15) is a 15-item self-report scale that measures thwarted belongingness (9 items) and perceived burdensomeness (6 items). Each item is measured on a 7-point Likert scale, with higher scores suggesting lower perceived connectedness. The score range for the entire scale is 15-105, with the score range for perceived burdensomeness being 6-42.
| units on a scale | BESST | Control |
|---|---|---|
| Connectedness: Interpersonal Needs Questionnaire-15 (INQ-15) Perceived Burdensomeness | 10.2 ± 5.98 | 17.4 ± 12.24 |
The Interpersonal Needs Questionnaire-15 (INQ-15) is a 15-item self-report scale that measures thwarted belongingness (9 items) and perceived burdensomeness (6 items). Each item is measured on a 7-point Likert scale, with higher scores suggesting lower perceived connectedness. The score range for the entire scale is 15-105, with the score range for thwarted belongingness being 7-63.
| units on a scale | BESST | Control |
|---|---|---|
| Connectedness: Interpersonal Needs Questionnaire-15 (INQ-15) Thwarted Belongingness | 29.1 ± 11.3 | 32.3 ± 15.72 |
The General Self-Efficacy Scale (GSES) is a valid scale of self-efficacy that is designed for the general population (12 years or older) and it has been tested in various countries. It is a 10-item psychometric scale that is designed to assess optimistic self-beliefs to cope with a variety of difficult demands in life. Total scores range from 10 to 40, with higher scores suggesting increased self-efficacy.
| units on a scale | BESST | Control |
|---|---|---|
| Patient Engagement: General Self-Efficacy Scale (GSES) | 30.4 ± 7.85 | 28.1 ± 6.59 |
The Suicide-Related Coping Scale (SRCS) includes 17 questions related to a patient's perception of their ability to cope with suicidal thoughts. Each item is assessed using a 5-point Likert scale. The scale includes two subscales including an External Coping subscale and an Internal Coping Subscale. The score range for the entire scale is 0-68 with the External Coping being 0-28 and the Internal Coping being 0-28. Higher scores indicate increased perception of suicide-related coping.
| units on a scale | BESST | Control |
|---|---|---|
| Patient Engagement: Suicide-Related Coping Scale (SRCS) External Coping Subscale | 24.6 ± 3.63 | 22.1 ± 7.26 |
The Suicide-Related Coping Scale (SRCS) includes 17 questions related to a patient's perception of their ability to cope with suicidal thoughts. Each item is assessed using a 5-point Likert scale. The scale includes two subscales including an External Coping subscale and an Internal Coping Subscale. The score range for the entire scale is 0-68 with the External Coping being 0-28 and the Internal Coping being 0-28. Higher scores indicate increased perception of suicide-related coping.
| units on a scale | BESST | Control |
|---|---|---|
| Patient Engagement: Suicide Related Coping Scale (SRCS) Internal Coping Subscale | 25.2 ± 4.39 | 20.2 ± 7.79 |
Suicide attempts is measured using the seven-item subscale on the Columbia-Suicide Severity Rating Scale (C-SSRS), a valid and reliable scale that asks patients to self-report on suicide attempts.
| Participants | BESST | Control |
|---|---|---|
| Number of Participants With Suicide Attempts | 0 | 0 |
The investigators will assess substance use at follow-up assessments using a timeline follow-back approach. This method is commonly used in research studies to assess substance use patterns. Numerical scores do not apply to this assessment.
| Participants | BESST | Control |
|---|---|---|
| Number of Participants With Substance Use at 3 Months Post-baseline | 3 | 5 |
Collected over Adverse event data were collected throughout the entirety of the study participant activities (approximately 3 months).. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| BESST | 0/10 (0%) | 0/10 (0%) | 4/10 (40%) |
| Control | 0/10 (0%) | 0/10 (0%) | 4/10 (40%) |
| Event | BESST | Control |
|---|---|---|
| Suicidal behaviorPsychiatric disorders | 2/10 | 4/10 |
| Psychological distressPsychiatric disorders | 2/10 | 0/10 |
| Age, Continuous(years) | BESST | Control | Total |
|---|---|---|---|
| Mean | 42.7 ± 9.08 | 42.0 ± 11.63 | 42.35 ± 10.16 |
| Sex: Female, Male(Participants) | BESST | Control | Total |
|---|---|---|---|
| Female | 1 | 1 | 2 |
| Male | 9 | 9 | 18 |
| Ethnicity (NIH/OMB)(Participants) | BESST | Control | Total |
|---|---|---|---|
| Hispanic or Latino | 1 | 0 | 1 |
| Not Hispanic or Latino | 9 | 10 | 19 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Race (NIH/OMB)(Participants) | BESST | Control | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 0 | 0 | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 0 | 0 | 0 |
| White | 10 | 10 | 20 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Region of Enrollment(Participants) | BESST | Control | Total |
|---|---|---|---|
| United States | 10 | 10 | 20 |
| The Beck Scale for Suicidal Ideation (BSS)(units on a scale) | BESST | Control | Total |
|---|---|---|---|
| Mean | 4.6 ± 6.293 | 9.4 ± 9.8 | 7.0 ± 8.39 |
| The Beck Scale for Hopelessness (BHS)(units on a scale) | BESST | Control | Total |
|---|---|---|---|
| Mean | 9.8 ± 4.49 | 8.7 ± 3.43 | 9.25 ± 3.93 |
| Interpersonal Needs Questionnaire-15, Perceived Burdensomeness (INQ-15 PB)(units on a scale) | BESST | Control | Total |
|---|---|---|---|
| Mean | 16.2 ± 8.65 | 15.3 ± 6.82 | 15.75 ± 7.59 |
5 further baseline measures are reported on the registry.
Documents are hosted by the registry — open the source record to download them.
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White River Junction Veterans Affairs Medical Center