# Development of a Novel Couples-Based Suicide Intervention: Treatment for Relationships and Safety Together (TR&ST)

> **NIH VA IK2** · VA SAN DIEGO HEALTHCARE SYSTEM · 2024 · —

## Abstract

Background: Suicide is one of the leading causes of death in the United States and worldwide, with suicide
rates among U.S. military veterans doubling (27.7 per 100,000) the rate of civilian levels (14.7 per 100,000).
Despite a rise in prevention efforts, rates have continued to increase. Theories of suicide and rehabilitation
psychology stress the importance of the person-environment interaction in contributing to one’s disability
experience. Specifically, research has consistently found that the most frequent precipitant of suicide is a
problem with a romantic partner. Conversely, people with better relationship functioning are less likely to have
suicidal thoughts. The International Classification of Functioning, Disability and Health (ICF) identifies social
engagement and communication as important components of functioning. Prevention of suicide in at-risk
veterans is of vital importance and the quality of one’s intimate relationship is an understudied intervention
target for suicide prevention. This proposal refines and evaluates preliminary efficacy of the first couples-based
suicide-specific intervention—Treatment for Relationships and Safety Together (TR&ST).
Significance/Innovation: Suicide prevention is the top clinical priority for VA/DoD. The importance of including
family members in Veterans’ suicide-related care is a critical component of the National Strategy for Preventing
Veteran Suicides 2018-2028 and key finding from VA/DoD patient focus groups conducted for the 2019
VA/DoD Clinical Practice Guidelines for the Assessment and Management of Patients at Risk for Suicide.
Innovative aspects of this CDA-2 proposal directly address several components of national reports and include:
1) The first couples-based suicide-specific intervention and the first suicide-specific intervention to target
interpersonal functioning factors identified by suicide theories and rehabilitation psychology (i.e., effective
communication and interpersonal engagement); 2) Veteran-centric choice between home-based telemental
health and office-based care in order to increase access; and 3) Improved data analytic quality of Veteran
suicidality by examining both Veteran and partner reports of suicide related risk factors (the first suicide-
specific treatment study to do this).
Methodology: The proposed 5-year study consists of two phases. Phase 1: treatment refinement with 10
couples (N=20) and Phase 2: pilot Randomized Controlled Trial (RCT) of TR&ST compared to VA Standard
Suicide Intervention with 60 couples (N=120). The intervention period is 13 weeks and the entire study period
is approximately 7 months. Couples in both phases will be quantitatively assessed at baseline, mid-treatment,
post-treatment, and 3-months post-treatment (and qualitatively interviewed following each TR&ST module).
The primary outcome to be evaluated is change in suicidal ideation severity. Secondary outcomes concern
changes in interpersonal functioning.
Aims: Aim 1 (Phase 1): Ref...

## Key facts

- **NIH application ID:** 10834890
- **Project number:** 5IK2RX003490-04
- **Recipient organization:** VA SAN DIEGO HEALTHCARE SYSTEM
- **Principal Investigator:** Chandra Khalifian
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-04-01 → 2026-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10834890

## Citation

> US National Institutes of Health, RePORTER application 10834890, Development of a Novel Couples-Based Suicide Intervention: Treatment for Relationships and Safety Together (TR&ST) (5IK2RX003490-04). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10834890. Licensed CC0.

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