# Virtual Hope Box Enhanced Facilitation in High-Risk Suicidal Veterans

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2024 · —

## Abstract

Background: Veteran suicide rates are 1.5 times higher than the general population rates and are especially
high following discharge from an inpatient mental health unit when up to a third of patients do not receive
timely outpatient follow-up care. Technology-based interventions are a scalable approach to provide additional
support to patients during these high-risk transitions. The Virtual Hope Box (VHB), a mobile phone application
(app) developed by the Department of Defense (DoD) and VA, allows patients to access reasons for living and
coping tools regardless of their location. VHB was effective for improving coping self-efficacy in a small
randomized controlled trial; however, no studies have been adequately powered to examine VHB’s
effectiveness for suicide attempts. Additionally, knowledge and use of the app is low according to a preliminary
study of mental health inpatients, calling for new strategies to facilitate greater use and impact of the VHB app.
Significance: The suicide rate among Veterans rose 35.9% from 2001 to 2019, leading to VA to make suicide
prevention a top clinical priority. We developed an intervention, which includes the VHB app and its enhanced
facilitation (VHB-EF), with the aim of reducing Veteran suicide attempts. Developing and implementing
effective strategies to reduce suicide attempts post-hospitalization is also a research priority within this RFA.
Innovation/Impact: We developed VHB-EF to provide awareness, active engagement, and support of VHB
with the aim of reducing suicide attempts post-hospitalization. This study will be the first to test the
effectiveness of VHB-EF on suicide attempts and may improve safety after discharge. It will examine potential
intervention mechanisms, according to self-efficacy theory and the theory of planned behavior, while also
considering ultimate implementation and scalability of the VHB-EF through provider and Veteran feedback.
Specific Aims: Aim 1: Determine the effectiveness of VHB-EF for reducing suicide attempts. Aim 2: Examine
the intervention mechanisms by measuring the effects of VHB-EF on 1) reasons for living, and 2) self-efficacy
to (a) cope and (b) refrain from suicide attempts. Exploratory Sub-aim 2: Examine whether higher reasons for
living and self-efficacy partially mediate the effect of VHB-EF on suicide attempts over 6 months. Aim 3:
Assess the determinants (barriers and facilitators) of VHB-EF adoption to inform future implementation and
sustainability of VHB-EF across the VA.
Methodology: A randomized effectiveness-implementation Hybrid Type I trial will be conducted at two VHA
inpatient mental health units. We will randomize 928 Veterans hospitalized after a suicidal crisis to either VHB-
EF or Enhanced Usual Care (EUC). The VHB-EF includes a single session on the unit that educates Veterans
on app purpose for suicide prevention, loads the app on their personal phone, provides practice of each app
component, and discusses strategies to enhance app usage a...

## Key facts

- **NIH application ID:** 10635900
- **Project number:** 1I01HX003502-01A2
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** COURTNEY L BAGGE
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2024-06-01 → 2029-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10635900

## Citation

> US National Institutes of Health, RePORTER application 10635900, Virtual Hope Box Enhanced Facilitation in High-Risk Suicidal Veterans (1I01HX003502-01A2). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10635900. Licensed CC0.

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