2019 HSR&D/QUERI National Conference

4054 — Mindfulness-Based Cognitive Therapy for Preventing Suicide in Military Veterans: An Examination of Short-Term Outcomes

Lead/Presenter: Alejandro Interian,  VA New Jersey Healthcare System
All Authors: Interian A (VA New Jersey Healthcare System), Stanley B (Columbia University College of Physicians & Surgeons; New York State Psychiatric Institute), Chesin M (William Paterson University; VA New Jersey Healthcare System) Latorre M (VA New Jersey Healthcare System) St. Hill L (VA New Jersey Healthcare System) Miller R (VA New Jersey Healthcare System) King A (VA New Jersey Healthcare System) Boschulte, D (VA New Jersey Healthcare System) Gara M (Rutgers-The State University of New Jersey, Robert Wood Johnson Medical School) Kline A (Rutgers-The State University of New Jersey, Robert Wood Johnson Medical School)

A critical need exists for research on effective interventions that reduce suicide in Veterans. To address this need, a randomized controlled trial evaluated Mindfulness-Based Cognitive Therapy for Suicide (MBCT-S). Study aims were to evaluate whether MBCT-S augmented VHA treatment-as-usual (TAU) in reducing: 1) time to suicidal event (i.e., suicide behavior or suicide-related emergency service); 2) time to suicide attempt; and 3) other suicide-related factors.

Veterans at high-risk for suicide (N = 140) were randomized to either MBCT-S+TAU or TAU only (control). Three assessments occurred over 3 months: baseline; mid-treatment; and post-treatment. Outcomes included suicidal ideation, suicide attempts, depression severity, hopelessness, distress tolerance, and suicide-related coping. Analyses adopted an intent-to-treat analytic approach.

The MBCT-S condition showed a significant advantage over control on time to a suicide attempt (p = .046). Within 100 days, 5 (7%) of MBCT-S participants made suicide attempt, compared to 13 (18.8%) in the control group (Number-needed-to-treat = 8.48). Also, MBCT S participants showed significantly greater improvements than controls in distress tolerance across time (p = .004). Significant effects were not observed for time to suicidal event, suicidal ideation, depression, and hopelessness. Since 50.7% of participants were receiving VHA residential care, stratified analyses evaluated the influence of this important TAU context. Notably, across several outcomes, MBCT-S showed a stronger advantage over control among participants receiving VHA residential treatment. Time to suicide attempt was significantly different only among participants receiving residential treatment (p = .003), not among outpatients. Among those receiving residential care, suicide attempts at 100 days occurred in 0 (0%) MBCT-S participants, compared to 9 (13.0%) controls. Similarly, only MBCT-S participants receiving VHA residential care showed significantly greater improvement over time than controls on depression (p = .032), hopelessness (p = .002), and distress tolerance (p = .002).

MBCT-S shows promise for reducing suicide attempts and improving other key outcomes among Veterans at high-risk for suicide, particularly when received concurrently with VHA residential care.

A recent HSRandD evidence synthesis report noted the gap in suicide prevention studies targeting high-risk Veterans. The findings of this study directly address this gap, showing promise for an intervention, MBCT-S, that can be integrated within existing VHA programs.