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Rocky Mountain MIRECC for Suicide Prevention - Research Projects

Updated: 10 January 2017

Research Projects

Research is not a sequential process but one that is at time additive and at other times innovative.

 

Welcome to the Rocky Mountain MIRECC Selected Research Projects

Simply click on the plus (+) symbol to expand the section and read more about each selected research project. And the minus (-) to close that section.

Understand

This phase includes Foundational Science, Epidemiology and Etiology (note that there is overlap between phases).
Foundational Science can be thought of as that discovery phase, the starting point of exploring scientific ideas.
Epidemiology is the work of describing a population; the patterns, causes and effects of health and disease.
And Etiology is the biological, psychosocial and environmental causes associated with a disease of condition.

Screen/Assessment

After the initial phase we can build on our understanding and begin to explore Prevention & Screening and Treatment.
Prevention and Screening includes population and selective interventions that focus on the prevention of a disease or condition; this also includes studies that explore screening measurements and assessment tools to identify a disease or condition.
Treatment studies are designed to test how well a specific intervention works with a specific population or group.

Treatment

The third phase is Treatment, again, note the overlapping nature of research. Areas in this phase include Treatment, Follow-up Care and Services Research.
Follow-up Care looks at how well the treatment works over extended periods of time and the potential side-effects.
Services Research focus on the delivery of care and how well the treatment as been implemented.

The Adolescent Brain Cognitive Development (ABCD) Study

Research Study Leader: Deborah Yurgelun-Todd, Ph.D.

Research Study Co-Leaders: Perry F. Renshaw, MD, PhD, MBA and Erin McGlade, PhD

Research Study Coordinators: Jennifer DiMuzio, Elliott Bueler, Kirsten Cline, Punitha Subramaniam, Daniel Epstein, Nicole Fisher

Research Questions: The primary objectives of the study are to Identify individual developmental trajectories (e.g., of brain, cognitive, and emotional development, and academic progress), and the factors that can impact them. In addition, this study aims to develop national standards of normal brain development in youth. Furthermore, this data will help to determine how exposure to various levels and patterns of alcohol, tobacco, nicotine, caffeine, and other substances affect developmental outcomes and vice versa.

Description: The primary aim of the ABCD Consortium is to study approximately 12,000 youth, enrolling them at age 9-10 across the country, and following them for 10 years, creating an unprecedented data resource for scientists to share for studies of the adolescent brain. This study will include multimodal neuroimaging, clinical and environmental measures and neuropsychological testing.

Current outcomes: Study to begin shortly.

Relation to Research Continuum: Understanding Suicide Prevention

Brain Chemistry and Altitude in Bipolar Disorder

Research Study Leader: Perry F. Renshaw, MD, PhD, MBA

Research Study Coordinator: Colin Riley

Research Questions: The primary objectives are to determine whether brain metabolites and brain pH will differ among euthymic, depressed BD subjects and healthy controls at different altitudes.

Description: The aim of this two-site study is to ascertain the role of altitude on brain chemistry in bipolar disorder. The study consists of two sites, one in Boston, MA and the other in Salt Lake City, UT. Veterans with bipolar I in either depressive or euthymic states (as determined by several clinical interviews) are being recruited, along with healthy controls, to undergo magnetic resonance spectroscopy (MRS) in order to characterize the effect of altitude on the interrelationship between brain pH, glutamate, lactate and mood state in bipolar disorder and to compare the effects of altitude on measures of brain chemistry in depressed and euthymic veterans with bipolar disorder, and healthy controls. The goal is to enroll a total of 60 veterans: 20 healthy controls, 20 euthymic bipolar, and 20 depressive bipolar veterans.

Current outcomes: At the Salt Lake City site, to date, 64 total veterans have been consented, with 58 enrolled. 35 of these were healthy controls and 23 had bipolar disorder. We have scanned a total of 43 veterans; 23 healthy controls and 20 bipolar veterans (12 euthymic, 8 depressive) with 4 currently waiting to be scanned.

Relation to Research Continuum: Understanding Suicide Prevention

Coalition for Recovery and Innovation in Traumatic Brain Injury Care Across the Lifespan (CRITICAL)

Research Study Leader: Nathaniel Mohatt, Ph.D.

Traumatic Brain Injury (TBI) is now recognized as a chronic condition, with life-long health implications. This project will establish a TBI patient and stakeholder advisory committee to steer patient-centered TBI outcomes research. The study objectives are: 1) to develop resources and strategies for engaging those with moderate to severe TBI and associated cognitive impairments in Community Based Participatory Research; and 2) to establish a research agenda for clinical effectiveness research to improve patient-defined TBI outcomes across the lifespan.

Relation to Research Continuum: Treatment

Creatine Augmentation for Females with Treatment-Resistant Major Depressive Disorder

Research Study Leader: Perry F. Renshaw, MD, PhD, MBA

Research Study Co-Leaders: Young-Hoon Sung, MD and Xianfeng Shi, PhD

Research Study Coordinator: Danielle Boxer, MS

Description: This is a placebo-controlled translational target engagement study, enrolling females aged 12-21 with major depressive disorder, who remain clinically depressed despite treatment with a selective-serotonin reuptake inhibitor (SSRI) antidepressant.

Current outcomes:
Kondo DG, Forrest LN, Shi X, Sung YH, Hellem TL, Huber RS, Renshaw PF. Creatine target engagement with brain bioenergetics: a dose-ranging phosphorus-31 magnetic resonance spectroscopy study of adolescent females with SSRI-resistant depression. Amino Acids. 2016 Aug;48(8):1941-54. doi: 10.1007/s00726-016-2194-3. Epub 2016 Feb 23.

Relation to Research Continuum: Understanding Suicide Prevention

Double-Blind Placebo-Controlled Study of Lithium for Preventing Repeated Suicidal Self-Directed Violence in Patients with Depression or Bipolar Disorder

Research Study Leader: Hal S. Wortzel, MD

Research Study Coordinator: Pamela McAlpin

Research Questions: Data from observational studies and double-blind randomized clinical trials suggest that lithium can prevent suicide-related behaviors in patients with bipolar disorder and major depression.

  • The high risk of suicide in veterans receiving health care services from VHA has persisted despite extensive improvements in mental health services and in programs for suicide prevention.
  • Each month, there are over 1,000 unique VHA patients with bipolar disorder or depression who attempt suicide and survive.
  • Surviving a suicide attempt is the most powerful known risk factor for death from suicide in VA and elsewhere.
  • Approximately 15% of VA survivors reattempt or die from suicide within one year.
  • Evaluating rates of reattempts in those who have survived attempts is an established and effective method for testing interventions that may prevent suicide.
  • Experimental treatment in CSP-590 would supplement usual care for major depression or bipolar disorder.
  • Study procedures for the management of suicide risk would meet or exceed VA standards and requirements

Relation to Research Continuum: Screen/Assessment

Double-Blind Placebo-Controlled Study of Lithium for Preventing Repeated Suicidal Self-Directed Violence in Patients with Depression or Bipolar Disorder - CSP #590

Research Study Leader: Perry F. Renshaw, MD, PhD, MBA

Research Study Co-Leaders: Deborah Yurgelun-Todd, Ph.D., Erin McGlade, PhD and Margaret Legarreta, PhD

Research Study Coordinator: Mallory Rogers, Karen Stagnaro, RN

Research Questions:

  1. Does lithium decrease the total number of suicidal behaviors?
  2. Does lithium have comparable effects on impulsive and non-impulsive behaviors?

Description: 30 sites nationwide are actively recruiting Veterans with recent suicide attempts—or ideation with hospitalization—to participate in a double-blind placebo-controlled study of Lithium. Participants will receive the study drug for one year, with intermittent assessments for suicidality and mood disorder symptoms. To ensure safety while maintaining the study blind, participants will be monitored by VA lab system for Lithium levels and side effects.

Current outcomes: Although the study team is actively recruiting through several avenues, no participants have been enrolled at the Salt Lake City site yet.

Relation to Research Continuum: Treatment

The Effect of Altitude on Depression for Individuals of Different Diet, Age, and Gender in the United States. NHANES 2000-2012 (National Health and Nutrition Examination Survey)

Research Study Leader: Perry F. Renshaw, MD, PhD, MBA

Research Study Co-Leaders: Amanda Bakian, PhD and Rebekah Huber, PhD

Research Study Coordinator: Lindsay Scholl

Description: This study is an epidemiologic investigation of the associations and interactions between depressive symptoms, and a host of other respondent characteristics. It is a secondary analyses of Centers for Disease Control and Prevention (CDC) data sets that were collected for the NHANES (National Health and Nutrition Examination Survey) project from 2000 through 2012. To date we have not been able to investigate the potential effects of altitude on the mental health of veterans specifically; this study is designed to accomplish that goal.

Current outcomes: The study is in-progress.

Relation to Research Continuum: Understanding Suicide Prevention

The Effectiveness of rTMS in Depressed VA Patients - CSP #556

Research Study Leader: Perry F. Renshaw, MD, PhD, MBA

Research Study Co-Leaders: Phillip Gale, DO and Ubaid Zafar, MD

Research Study Coordinator: Mallory Rogers

Research Questions:

  1. To assess the efficacy of rTMS in Veterans with Treatment Resistant Major Depression (TRMD) to bring about remission of TRMD.
  2. To evaluate the durability of benefit of rTMS treatment in TRMD; to determine whether depressive symptoms, suicidality, PTSD symptoms, substance abuse, cognitive function, and quality of life improve with rTMS treatment; to evaluate cost offset of rTMS in the treatment of depression in the VA Healthcare System.

Description: rTMS (Repetitive Transcranial Magnetic Stimulation) is a method of delivering stimulation to the brain without the side effects of electroconvulsive therapy and antidepressant medications. CSP 556 enrolled approximately 180 Veterans with treatment-resistant depression to participate in a double-blind placebo-controlled study of rTMS treatments. Patients received 20-30 sessions, with intermittent assessments for suicide safety, MDD symptoms, PTSD symptoms, and neuropsychological functioning. Participants were followed for 6 months after receiving treatment.

 

Current outcomes:

Relation to Research Continuum: Treatment

Feasibility Trail of the Collaborative Assessment and Management of Suicidality Group (CAMS-G)

Research Study Leader: Peter Gutierrez PhD

Research Study Co-Leaders: Dr. Keith Jennings

Research Study Coordinator: Nora Mund, BA

Research Questions:

  1. Are the standardized training materials and the group manual adequate to allow clinicians to become adherent with the CAMS-G framework?
  2. Will the participant outcome measures confirm CAMS-G framework to be effective?

Description: The Collaborative Assessment and Management of Suicidality (CAMS) is a tool used in a therapeutic setting to assist clinicians in their engagement of patients who are suicidal. The framework of the tool is designed to focus on direct “drivers” of suicide, what are the underlying causes of suicidal ideation. Focusing on drivers will help clinicians engage, assess, and provide suicide-specific problem-focused treatments and interventions for suicidal patients.

The Feasibility Trail of the Collaborative Assessment and Management of Suicidality Group (CAMS-G) study investigates whether the basic training model and standards for CAMS in a group environment is optimal for keeping clinicians adherent to the framework. Adherence to training is assessed with an anchored CAMS rating scale, per each session recorded.

The participants also receive a baseline and follow-up measurements to confirm that worsening of symptoms do not occur. This study is being conducted at the Golden, CO VA Community Based Outpatient Clinic (CBOC).

Current outcomes: This study is actively recruiting.

Relation to Research Continuum: Treatment

Immune Activation and the Polytrauma Clinical Triad Research Study

Research Study Leader: Amy Starosta PhD - 303-399-8020 ext5175

Research Study Co-Leaders: Lisa Brenner PhD

Description: This a cross-sectional study examining the relationship between inflammation and symptoms of chronic pain, post-traumatic stress disorder, and persistent post concussive symptoms following traumatic brain injury. We are seeking male Veterans between the ages of 18-45 to attend one study session at the Denver VA. Participants will complete questionnaires and provide a blood sample.

Current outcomes: This study is actively recruiting.

Relation to Research Continuum: Treatment

Impact of Altitude on Mood Disorders, Antidepressant Function and Methamphetamine Abuse in an Animal Model

Research Study Leader: Perry F. Renshaw, MD, PhD, MBA

Research Study Co-Leaders: Shami Kanekar, PhD

Research Study Coordinator: Chandni Sheth, PhD, Matt Peterson

Description: Demographic studies find that living at altitude (hypobaric hypoxia) or with chronic hypoxic disorders (COPD, cardiovascular disease, smoking) increase the risk for depression and suicide. Living with chronic hypoxia exposure may thus increase rates of treatment-resistant depression, to worsen suicidal ideation and suicide attempts. We use a translational animal model to examine the effects of chronic hypoxia exposure on depression and antidepressant function.

(2) Effects of Altitude on Methamphetamine Preference in an Animal Model: This study is based on demographic finding that living at altitude is an independent risk factor for methamphetamine addiction. We use a novel animal model to test for the impact of housing at altitude on methamphetamine preference.

(2) Effects of Altitude on Anxiety-like Behavior in an Animal Model: Since anxiety is often comorbid with depression in people, we have recently initiated a study to examine whether exposure to altitude can increase anxiety-like behavior in a rodent model.

Current outcomes: In progress

Relation to Research Continuum: Understanding Suicide Prevention

Military Sexual Trauma and Suicidal Thoughts and Behaviors

Research Study Leader: Lindsey Monteith, PhD

Research Study Coordinator: Holly Gerber

Research Question: How does MST impact the lives of Veterans? How does MST contribute to suicidal thoughts and behaviors?

Description: This study consists of a 1-time, 2-hour individual appointment in which participants answer interview and survey style questions pertaining to their military experiences, thoughts and feelings they have had, and substance use.

Relation to Research Continuum: Understanding Suicide Prevention

MRI Analysis of Coil Position to Improve the rTMS Treatment of Depression

Research Study Leader: Deborah Yurgelun-Todd, Ph.D.

Research Study Co-Leaders: Perry F. Renshaw, MD, PhD, MBA and Erin McGlade, PhD

Research Study Coordinator: Mallory Rogers

Research Questions: The study aims to include individual differences in TMS coil location defined on the scalp by the 6 cm rule. This will be correlated with treatment response of patients in CSP 556 in the active treatment group, but not the sham treatment group. Brain atrophy, specifically scalp to cortex distance (SCD) will also be associated with treatment response in the active group but not the sham group. Furthermore, the economic analyses from the study will to help assess the cost-effectiveness of using MRI in rTMS.

Description: The purposes of this project are to perform MRI in 120 of the 360 CSP 556 enrollees and relate MRI-derived information to the magnitude of treatment response.

Current outcomes: Study in progress.

Relation to Research Continuum: Treatment

Neurobiology of Impulsivity and Aggression in Female Veterans

Research Study Leader: Erin McGlade, Ph.D.

Research Study Co-Leaders: Deborah Yurgelun-Todd, Ph.D.

Research Study Coordinator: Jennifer DiMuzio

Research Questions: We hypothesize females with and without suicidal behavior will differ in their anterior cingulate volume. We also theorize females with suicide attempts will have higher impulsivity and aggression than females without suicidal behavior and their anterior cingulate volume will be correlated with impulsivity, suicidal behavior and aggression. Furthermore, this study hopes to explore sex differences between male and female Veterans to help better understand clinical presentation and improve mental health treatments.

Description: The purpose of this project is to look at female Veterans with suicidal behavior compared to female Veterans without suicidal behavior.

Current outcomes: Study in progress.

Relation to Research Continuum: Understanding Suicide Prevention

Neurobiology of Self-Directed Violence in Veterans with Chronic Pain and Traumatic Brain Injury

Research Study Leader: Margaret Legarreta, Ph.D.

Research Study Co-Leaders: Deborah Yurgelun-Todd, Ph.D. and Erin McGlade, PhD

Research Study Coordinator: Elliott Bueler

Research Questions: The primary objectives of the study are to see if participants with co-morbid chronic pain and TBI will report higher rates of historical SDV compared to participants with TBI or chronic pain alone and participants without chronic pain or TBI as well as if participants with co-morbid chronic pain and TBI will demonstrate more chronicity of SDV as measures by frequency, duration, and controllability of suicidal ideation, number of suicide attempts, and lethality of the attempts.

Description: The purpose of this project is to look at differences in self-directed violence (SDV) between participants with chronic pain, participants with TBI, participants with chronic pain and comorbid TBI, and participants without chronic pain or TBI to evaluate the relationships between TBI, chronic pain, and SDV.

Current outcomes: Study in progress.

Relation to Research Continuum: Understanding Suicide Prevention

Neuroimaging Correlates of Suicide Risk Assessment

Research Study Leader: Deborah Yurgelun-Todd, Ph.D.

Research Study Co-Leaders: Erin McGlade, Ph.D

Research Study Coordinator: Elliott Bueler

Research Questions:

  1. To further clarify the sequelae of mTBI, the relationship between the integrity of the frontal systems, as measured by DTI and fMRI, and clinical outcome, including PTSD symptomotology and suicidal ideation will be examined.

Description: The evaluation of the neurophysiologic and cognitive predictors of suicide risk and recovery are needed to improve treatments. We believe the proposed studies will impact veteran’s health by providing important insights into the neurobiological correlates of suicide that may lead to new approaches for identification and treatment of behavioral consequences of TBI.

Current outcomes: Study recently completed enrollment and is now in analysis phase.

Relation to Research Continuum: Screen/Assessment

Omega 3s in Male Veterans with Multiple Sclerosis (MS)

Research Study Leader: Daniel Hadidi

Research Study Co-Leaders: Lisa Brenner, PhD, Jeff Hebert, PT, PhD, Peter Torberntsson, MD

Research Study Coordinator: Daniel Hadidi

Research Questions:

  1. Are dietary and blood levels of Omega 3 and the Omega 6:3 ratio associated with quality of life, relapse rate, disability level and disease severity?
  2. What are male Veterans’ with MS behaviors and attitudes with regard to diet, especially animal products?
  3. Are dietary levels of Omega 3 and Omega 6:3 ratio associated with blood levels?

Description: This is a cross-sectional study of diet in male Veterans with Multiple Sclerosis. 200 individuals are being sought to participate in this study, in which they will spend approximately 2 hours (single visit) filling out questionnaires on their diet and supplement use, quality of life, and demographic/health information related to their Multiple Sclerosis. There is also an optional blood drop sample which can be collected from up to 100 individuals. This will analyze the levels of Omega 3 and Omega 6 fatty acids in the blood.

Relation to Research Continuum: Screen/Assessment

The Study of Neurobiological Responses to Facial Affect using fMRI and EEG

Research Study Leader: Deborah Yurgelun-Todd, Ph.D.

Research Study Co-Leaders: Daniel Epstein and Erin McGlade, PhD

Research Study Coordinator: Elliott Bueler

Research Questions: The outcome of this project is to determine differences in brain activity in response to masked fearful face stimuli in subjects with PTSD and healthy comparison volunteer as well as ascertain if a correlation exists between brain activity measured using EEG activity measured using fMRI in response to viewing masked fearful faces and determine whether brain activity in response to this task is associated with trait anxiety and symptom severity in study participants.

Description: The purpose of this study is to examine the neurobiological and behavioral correlates of responses to facial affect in a PTSD population using both FMRI and EEG.

Current outcomes: Study in progress.

Relation to Research Continuum: Understanding Suicide Prevention

Target Engagement Neuroimaging Study of Uridine in Suicidal Veterans

Research Study Leader: Douglas Kondo, MD

Research Questions: We hypothesize that alterations in glutamatergic neurotransmission, and the energy-intensive oral administration of uridine will be deployed as a “neurochemical probe,” to determine whether changes in Gln/Glu or GABA in the brain are associated with changes in the results of valid, standardized clinical assessment measures of suicidal ideation and behavior.

Current outcomes: Funding requested.

Relation to Research Continuum: Understanding Suicide Prevention

Toward a Gold Standard for Suicide Risk Assessment for Military Personnel

Research Study Leader: Peter Gutierrez PhD

Research Study Co-Leaders: Dr. Thomas Joiner

Research Study Coordinator: Jetta Hanson, MA, LPC

Research Questions:

  1. Are the four measures psychometrically sound when used with active duty military personnel?
  2. Which measure is most effective at predicting service members’ referral for emergency services due to suicidal crisis or engagement in suicidal behavior within three months of initial assessment?
  3. Do self-report measures perform as well or better than interview-based assessments?
  4. Does combining self-report and interview assessment approaches significantly increases predictive power?

Description: Individuals come to the attention of inpatient psychiatry, outpatient behavioral health, and emergency department providers for a wide variety of reasons, few more pressing than concerns about risk of suicide. Once face-to-face with a provider, the ultimate question is always a variant of “How can I best assess this individual in order to predict if they will engage in suicidal behavior in the near future?” Providers want to know, what it is the “gold standard” for suicide risk assessment?

To date, the field has been unable to provide a definitive answer to this question. The Toward a Gold Standard for Suicide Risk Assessment for Military Personnel study will pit several psychometrically sound suicide risk assessment measures against one another, to determine which tool or combination of tools optimally assesses the likelihood of future suicide-related indices over a three month period, in a large sample of military personnel seeking services from or referred to inpatient psychiatry, outpatient behavioral health, or the emergency department because of suicide risk concern. It will also test whether brief self-report measures perform as well or better than more comprehensive interview-based assessment approaches and if there is a benefit to combining the two assessment methods.

Current outcomes: This study is actively recruiting from two military installations.

Relation to Research Continuum: Screen/Assessment

Uridine for Rapid-Acting Treatment of Veterans with Suicidal Ideation

Research Study Leader: Douglas Kondo, MD

Research Study Co-Leaders: Perry F. Renshaw, MD, PhD, MBA and Deborah Yurgelun-Todd, Ph.D.

Research Questions: This study includes a randomized, placebo-controlled pilot/feasibility study of uridine that includes a 6-month open-label extension that will serve to test the durability of treatment effects, and to provide data regarding uridine’s long-term safety, toxicity, acceptability and patient satisfaction.

Description: The anesthetic ketamine has shown promise as an antisuicidal medication; however, ketamine is a psychotomimetic (i.e. ketamine’s effects mimic schizophrenia), and there are concerns in the literature suggesting that ketamine may pose unacceptable risks for military personnel. Uridine is a “hypothesis-driven” intervention because uridine, ketamine and lithium (another drug believed to have anti-suicide properties) share a multitude of brain mechanisms and neural effects, that have been demonstrated using pre-clinical animal models and bench science.

Current outcomes: Funding requested.

Relation to Research Continuum: Understanding Suicide Prevention

 

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