The aims of this research are to: (1) develop and revise From Hardship to Hope, a peer-led intervention to empower individuals to manage their finances and thereby reduce suicidal ideation (SI) and suicide behaviors (SB); (2) assess how feasible and acceptable the new intervention is to participants, including their level of satisfaction; (3) examine its initial effect on SI intensity, utilization of financial supports, objective and subjective measures of financial hardship, and protective (e.g., hope, life satisfaction) and risk (e.g., hopelessness, depression) factors of suicide; and (4) explore the intervention's mechanisms of action (e.g., level of participation, subjective financial hardship). We hypothesize that SI intensity, hopelessness, and objective and subjective financial hardship will decrease after the intervention while utilization of financial supports and hope will increase. We further hypothesize that the amount of change in SI intensity will be positively correlated with the change in subjective financial hardship, and both will be associated with level of participation. We will assess SI intensity with the SI intensity subscale of the Columbia Suicide Severity Rating Scale. Other domains to be measured include: objective and subjective financial hardship, hope, life satisfaction, social support, hopelessness, depression, and psychiatric distress. The study follows a five-step intervention development design, with mixed quantitative and qualitative methods: (1) drafting of a preliminary version of the intervention with input from key stakeholders through several focus groups; (2) piloting this version with 10 participants and obtaining debriefing assessments on each component; (3) revising the intervention based on the findings from step 2; (3) conducting a single-group intervention trial to test the revised version (n=40), with quantitative assessments at baseline and weeks 3, 6, 9, 12 and 24 and focus group input from participants; and (5) final revision and manualization of the intervention. Peer providers will facilitate the intervention; these are individuals with lived experience of financial hardship and SI or SB who have received formal training and provide supports in a paid relationship. The intervention will be implemented over 24 weeks: the first 12 weeks consist of weekly group financial empowerment sessions, four one-on-one peer coaching sessions, and assistance navigating available financial supports (e.g., free financial counseling, tax credits, Social Security work incentives); the second 12 weeks involve 6 brief booster one-on-one phone sessions. Participants will be individuals experiencing current financial hardship and moderate-to-high suicide risk, recruited through websites and organizations serving people in financial and psychiatric distress, such as social services, employment search engines and agencies, and mental health programs. The main outcome of this study will be a manualized intervention to lessen financial hardship as a risk factor for SI/SB with preliminary evidence of its potential efficacy. Financial hardship is an important risk factor for suicide, and yet no evidence-based interventions are available in this area. Our project may provide feasible and implementable intervention strategies to lessen objective and subjective financial hardship, and thereby decrease SI/SB. If the intervention shows promise, the next steps involve testing it in a larger, randomized controlled trial with individuals with SI/SB.
