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Contemp Clin Trials. 2014 Mar;37(2):252-60. doi: 10.1016/j.cct.2014.01.007. Epub 2014 Jan 25.

Caring letters for suicide prevention: implementation of a multi-site randomized clinical trial in the U.S. military and Veteran Affairs healthcare systems.

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National Center for Telehealth & Technology, United States; Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine, Seattle, United States. Electronic address:
National Center for Telehealth & Technology, United States.
VA Western New York Healthcare System, United States.
Palo Alto VAHCS, Stanford University RPAC-SPECTRUM, United States.
Landstuhl Regional Medical Center, Germany.
Navy Medical Center San Diego, United States.
Tripler Army Medical Center, United States.


Caring letters is a suicide prevention intervention that entails the sending of brief messages that espouse caring concern to patients following discharge from treatment. First tested more than four decades ago, this intervention is one of the only interventions shown in a randomized controlled trial to reduce suicide mortality rates. Due to elevated suicide risk among patients following psychiatric hospitalization and the steady increase in suicide rates among the U.S. military personnel, it is imperative to test interventions that may help prevent suicide among high-risk military personnel and veterans. This paper describes the design, methods, study protocol, and regulatory implementation processes for a multi-site randomized controlled trial that aims to evaluate the effectiveness of a caring emails intervention for suicide prevention in the military and VA healthcare systems. The primary outcome is suicide mortality rates to be determined 24 months post-discharge from index hospital stay. Healthcare re-utilization rates will also be evaluated and comprehensive data will be collected regarding suicide risk factors. Recommendations for navigating the military and VA research regulatory processes and implementing a multi-site clinical trial at military and VA hospitals are discussed.


After-care; Contact; Inpatient psychiatry; Military veterans; Post-hospitalization; Suicide

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