# Caring Cards to and from Veterans: Feasibility and Acceptability of a Peer Approach to  Suicide Prevention and Recovery

> **NIH VA I21** · VA SAN DIEGO HEALTHCARE SYSTEM · 2021 · —

## Abstract

This proposal responds to RR&D's Small Projects in Rehabilitation Research Award (SPiRE). There is a strong
need to develop, evaluate, and implement translatable interventions aimed at reducing Veteran suicide. Caring
contacts for suicide prevention (i.e., staff send supportive letters to patients following psychiatric inpatient
stays) is an empirically supported, low-cost method for meaningfully reducing suicide risk and hospitalization
readmissions and, has been studied and applied in Veterans/VA settings. Peer support (i.e., persons with lived
mental health experience) in mental health recovery is another empirically supported approach. Peers'
involvement in mental healthcare improves patients' social functioning and community integration, as well as
reduces self-stigma and functional impairment. This proposal describes the Caring Cards (CC) intervention,
which is a novel integration of caring contacts and peers. In CC, outpatient Veterans with lived mental health
experience (peers) create hope-filled and inspiring cards that are then sent to other Veterans struggling with
mental health concerns. By design, CC increases social connectedness among participants to reduce suicide
risk, which is strongly associated with social disconnectedness. Indeed, there are two evidence-based social risk
factors of suicide: thwarted belongingness (TB; feeling like one does not belong) and perceived
burdensomeness (PB; feeling as though one's existence is a burden on others). CC combines both caring
contacts and peers to specifically target reductions in TB and PB by increasing social connectedness. This study
aims to establish the feasibility and acceptability of CC. Our initial quality improvement project provided
strong preliminary evidence for the feasibility and acceptability of the CC. The current proposal is for a single-
site, 2-year pilot trial that employs an open-trial, pre/post research design. We propose to recruit outpatient
Veterans with a history of high suicide risk to make up our CC group and serve as the card-makers (CMs). We
will recruit outpatient Veterans who are currently at high-risk for suicide to be our card-recipients (CRs). The
primary outcome (Aim 1) is to establish feasibility and acceptability of CC. Aim 2 will examine CC's ability to
reduce our primary outcomes (TB and PB) among CMs and CRs. Aim 3 will preliminary evaluate CC's ability to
increase social connectedness, as well as reduce suicide risk (i.e., suicidal ideation and behavior) among CMs
and CRs. CMs will meet in weekly groups, each for six months, over the course of one year; CRs will receive a
total of six cards, one per month. Monthly meetup groups will also be an optional venue for CMs and CRs to
meet each other in-person. Baseline and follow-up assessments will be completed at start and one month after
final group for CMs, or one month after the final card for CRs. This project builds on our preliminary data
which indicate that Veteran CMs are interested in and fi...

## Key facts

- **NIH application ID:** 10114919
- **Project number:** 1I21RX003445-01A1
- **Recipient organization:** VA SAN DIEGO HEALTHCARE SYSTEM
- **Principal Investigator:** BLAIRE Ehret
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-12-31 → 2022-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10114919

## Citation

> US National Institutes of Health, RePORTER application 10114919, Caring Cards to and from Veterans: Feasibility and Acceptability of a Peer Approach to  Suicide Prevention and Recovery (1I21RX003445-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10114919. Licensed CC0.

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