Suicide Risk Management Protocol for a Randomized Controlled Trial of Cardiac Patients Reporting Hopelessness.

BACKGROUND: Investigators conducting studies that include potentially suicidal individuals are obligated to develop a suicide risk management (SRM) protocol. There is little available in the literature to guide researchers in SRM protocol development. OBJECTIVES: The aim of the study was to describe an SRM protocol developed for a randomized controlled trial (RCT) currently enrolling cardiac patients who report moderate to severe levels of hopelessness. METHODS: The SRM protocol identifies suicidal ideation and measures ideation severity through use of the Columbia-Suicide Severity Rating Scale risk factor questions. Based on responses, study participants are deemed safe or at low, moderate, or high risk for suicide. The SRM protocol guides research staff through a plan of action based on risk level. The protocol further guides staff through a plan over the course of this prospective study-from hospital enrollment to home-based visits. RESULTS: Research staff are well trained to identify suicidal ideation risk factors, initiate specific questioning about suicidal intent, determine level of risk, identify protective factors and a safe environment, and make referrals if needed. Of the 51 patients hospitalized with cardiac disease who reported moderate to severe hopelessness, 43 scored at a safe suicide risk level and 8 scored at low risk. Thirty-five of the 51 patients enrolled in the RCT. Of the 35 participants who received home visits to date, there have been three instances of low and one instance of moderate suicide risk. The SRM protocol has been consistently and accurately used by research personnel in both hospital and home settings. One modification has been made to the protocol since study activation, namely, the addition of an assessment of counseling history and encouragement of continued counseling. Booster training sessions of research staff will continue throughout the course of the RCT. DISCUSSION: Use of the SRM protocol identifies study participants who are safe or at risk for suicide in both hospital and home settings, and research staff can refer participants accordingly. CONCLUSION: The SRM protocol developed for this RCT can serve as a model in the development of SRM protocols for future research in acute care, community, or home-based settings.

Reliability and Validity of the State-Trait Hopelessness Scale in Patients With Heart Disease and Moderate to Severe Hopelessness.

OBJECTIVE: The aim of this study was to evaluate the reliability and validity of the State-Trait Hopelessness Scale (STHS) in patients with heart disease who report moderate to severe state hopelessness. METHODS: Reliability, concurrent validity, and convergent validity were evaluated for 20 patients. RESULTS: Cronbach's α for the State and Trait subscales were .81 and .79, respectively. Strong correlations between the State Hopelessness Subscale and Patient Health Questionnaire-9 (r = 0.77, P < .001), State Hope Scale (r = -0.75, P < .001), EQ-5D-5L (r = 0.59, P < .005), and PROMIS-29 domains of depression (P = .72, P < .001), fatigue (P = .61, P < .001), and social roles (P = .45, P = .047) were found. There were strong correlations between the Trait Hopelessness Subscale and Trait Hope Scale (r = -0.58, P < .005), State Hope Scale (r = -0.49, P = .03), and PROMIS-29 fatigue domain (r = 0.54, P = .015). CONCLUSIONS: Findings support the reliability and validity of the STHS for evaluation of hopelessness in patients with heart disease.

Lack of perceived social support in patients with ischemic heart disease is associated with hopelessness.

OBJECTIVE: To evaluate perceived social support (PSS) in ischemic heart disease (IHD) patients who report hopelessness. METHODS: Using a cross-sectional design, 156 patients were screened during their hospitalization for moderate to severe state hopelessness. Twenty patients who reported hopelessness during hospitalization and maintained hopelessness one week after hospital discharge were included. RESULTS: A moderately strong negative correlation was identified between PSS and state hopelessness (r = -0.54, p = .014). PSS was significantly higher in married/partnered patients (26.7 ± 4.85) compared to unmarried/unpartnered patients (18 ± 9.18; t = 2.45, p = .035). CONCLUSIONS: Social support may help reduce hopelessness in vulnerable cardiac patients, especially those who are unpartnered.

Home- and Hospital-Based Cardiac Rehabilitation Exercise: The Important Role of Physician Recommendation.

Exercise reduces morbidity and mortality for patients with heart disease. Despite clear guidelines and known benefits, most cardiac patients do not meet current exercise recommendations. Physician endorsement positively affects patient participation in hospital-based Phase II cardiac rehabilitation programs, yet the importance of physician recommendation for home-based cardiac rehabilitation exercise is unknown. A prospective observational design was used to examine predictors of both home-based and Phase II rehabilitation exercise in a sample of 251 patients with coronary heart disease. Regression analyses were done to examine demographic and clinical characteristics, physical functioning, and patient's report of physician recommendation for exercise. Patients with a strong physician referral, who were married and older, were more likely to participate in Phase II exercise. Increased strength of physician recommendation was the unique predictor of home-based exercise. Further research is needed to examine how health professionals can motivate cardiac patients to exercise in home and outpatient settings.