Randomized Controlled Trial of a Strategic Disclosure Intervention for Suicide Attempt Survivors

Suicide attempt survivors are at increased risk for suicidal thoughts and behaviors, and may struggle to find supportive confidants for discussing suicidality.  Overt stigmatizing reactions, fear of stigma, internalized stigma, or perceived futility interfere with help-seeking for suicidality.  However, disclosure of suicidality can enhance support networks, provide opportunity for self-reflection, and challenge stigma.  A peer-led strategic disclosure intervention (the 2Share program) was developed through a collaborative process with suicide attempt survivors.  The program aids participants in evaluating the benefits and risks of disclosure, considering ways to disclose, and developing disclosure scripts.  A pilot randomized controlled trial (RCT) with community-dwelling attempt survivors (n = 38) found that intervention participants demonstrated significant decreases on internalized stigma and depression, and increases in self-esteem as compared with the control group; however, this study was small, did not evaluate changes over time and did not include a comparison group (peer support groups). 

The aim of the proposed research is to conduct a larger-scale RCT (n = 100) of the 2Share program for suicide attempt survivors with mood disorder, with three-month follow-up.  Outcome measures will include suicidal thoughts and behaviors, depression, internalized stigma, self-esteem, disclosure-related self-efficacy, and help-seeking intentions.  We expect that results will replicate previous findings on internalized stigma, depression, and self-esteem, and that intervention participants will have reductions in suicidal thoughts and behaviors, increases in help-seeking attitudes, and improved disclosure confidence. We will invite a quarter of participants for a series of qualitative interviews about experiences with disclosure.  The intervention will be co-facilitated by two trained individuals with lived experiences of suicide attempt(s).  Following random assignment to condition (intervention versus support group), participants will complete electronic baseline questionnaires, including demographic questionnaires and outcome measures.  Intervention participants will complete the program in three 2-hour sessions (conducted weekly).  All participants will complete the electronic post-questionnaire three weeks after the baseline questionnaire, and again at three-months post-intervention.