A protocol for a randomized controlled comparative effectiveness trial of two brief interventions focused on social and cultural connectedness to reduce risk for suicide and substance misuse in young Alaska Native people

BACKGROUND: Suicide among young people in Alaska Native (AN) communities was nearly unheard of through the establishment of statehood in 1959, but from 1960-1995, the suicide rate increased by approximately 500% during this period of rapid, imposed social transition. These disruptions increased conditions associated with suicide risk (e.g., substance use disorders, cultural disconnection), and challenged the community-level social safety net of youth protective factors. The purpose of this paper is to outline development and evaluation methodology for a comparative effectiveness trial of two virtual, culturally grounded, brief interventions to address suicide prevention among AN young people. The proposed study addresses significant gaps in culturally appropriate evidence-based programming to address suicide prevention among AN young people by comparing effectiveness of these two interventions. Findings from this study have potential to expand the range of accessible, critically important services to this population. METHODS: Our interventions will be targeted toward AN young people ages 14-24 who present with suicide attempt, ideation, or associated risk behaviors, including alcohol-related injury in the Yukon-Kuskokwim region or the Interior of Alaska. In this randomized controlled comparative effectiveness trial, 14-24-year-old AN individuals will receive either BeWeL (Because We Love You) which will comprise a 45-min virtual wisdom talk addressing family strengths and increasing protective factors (n = 185), or BeWeL + MISN (plus motivational interviewing about social networks), which will include an additional 15 min focused on discussion of the individual's social networks (n = 185). Both interventions will have two follow-up visits at 2 and 6 weeks. We will evaluate changes in both intervention groups from the baseline survey at 3, 6, and 12 months on primary outcomes of suicide-intent risk, depression, anxiety, frequency of alcohol use, and alcohol consequences and compare effectiveness between the two interventions. In our secondary aim, we will evaluate changes in both groups from the baseline survey at 3, 6, and 12 months on individual and community protective factors, social networks, and awareness of connectedness and compare effectiveness between the two interventions. DISCUSSION: This project has the potential to expand the range and effectiveness of suicide prevention services for AN young people and will help meet the need in Alaska to link clinical behavioral health services to AN community-based networks, and to engage local cultural resources in aftercare for individuals at risk for suicide. Findings have potential to provide practical information to advance the field of suicide prevention and enhance protective factors and resiliency among this population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05360888; Registered December 22, 2022. https://clinicaltrials.gov/study/NCT05360888 .