Despite the high risk of suicide among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) Veterans, there is currently no suicide-focused intervention for LGBTQ+ Veterans. This study will refine and pilot Qnnections, a novel group-based suicide prevention intervention that aims to increase social connection and functioning that is tailored to the unique experiences and risk factors of this population. The project will involve Veterans with lived experience in further refining Qnnections, and then will examine feasibility and acceptability of Qnnections and of study procedures in a pilot randomized clinical trial.
Qnnections: A Novel Suicide Prevention Intervention for Increasing Social Connection Among LGBTQ+ Veterans
Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) Veterans have the highest rates of suicidal thoughts and behaviors among United States and Veteran populations. These disparities are due in part to experiences of discrimination and stigma-based stressors, which hinder social connection and functioning. The need for interventions that target social disconnection in this population is evident. Yet, to date there are no suicide-focused interventions for LGBTQ+ Veterans. Theoretical and empirical research consistently identifies perceived burdensomeness and thwarted belongingness as suicide-specific risk factors in LGBTQ+ people. This proposal refines and pilots Qnnections - the first suicide prevention intervention tailored to LGBTQ+ Veterans - which aims to increase social connection and functioning through improving belongingness and reducing burdensomeness. Phase I (1.5 years) focuses on intervention refinement of Qnnections with an LGBTQ+ Veteran Advisory Board (n = 8) and expert mentors. In its current form, Qnnections is a 10-week group-based intervention intended to augment Veterans Affairs (VA) suicide prevention efforts, using a cognitive behavioral framework informed by LGBTQ-affirmative approaches to target social disconnection. After refinement by mentors and LGBTQ+ Veterans, a pilot open trial (n = 10) will engage LGBTQ+ Veterans at elevated risk for suicide and gather acceptability data. Following refinement from Phase 1, Phase 2 (3.5 years) includes a pilot randomized feasibility and acceptability trial (n = 48), with participants randomized to Qnnections (10 group sessions, safety plan, referrals) or an Enhanced Usual Care condition that contains elements of standard VA suicide prevention (safety plan, referrals). Veteran participants in both phases will complete quantitative assessments at baseline, mid-treatment, post-treatment, and ten-week follow-up. Qualitative data collection will occur at post-treatment. The focus is feasibility and acceptability of Qnnections and of study procedures.
