September 2023

In This Issue: HSR&D Research on Suicide Prevention

Combined Transcranial Magnetic Stimulation and Brief Cognitive Therapy to Reduce Suicide Behavior in High-Risk Veterans

Feature Article

Takeaway: With recent research indicating that the suicide rate for Veterans is 57% higher than that of non-Veterans, ³ more effective treatment to reduce suicide is critical. This study is testing the impact of adding transcranial magnetic stimulation, a noninvasive technique that can reduce psychiatric symptoms associated with suicide risk, to brief cognitive behavioral therapy to reduce Veterans’ rates of suicide ideation and related behaviors.

In 2020, there were 6,146 Veteran suicides, a rate 57% higher than that of non-Veteran U.S. adults. ⁴ Finding ways to enhance treatment efficacy for reducing suicide is critical. Brief cognitive behavioral therapy (BCBT) is a well-established and effective treatment that is widely implemented across VA healthcare systems, but not all patients respond to BCBT. Transcranial magnetic stimulation (TMS)—a noninvasive technique that can reduce psychiatric symptoms associated with suicide risk, including depression and PTSD—might be an optimal treatment to use in conjunction with BCBT. TMS is not associated with the systemic and costly side effects associated with medications used for these disorders.

This ongoing study (May 2019–April 2024)—the first to examine the efficacy of combined treatment specifically for suicide prevention—is testing the effect of adding repetitive TMS to BCBT to reduce Veterans’ rates of suicide ideation and related behaviors. With a sample of Veterans hospitalized for suicide behavior, researchers will conduct a randomized controlled trial to evaluate the effect of adding a standard TMS course of treatment to BCBT to reduce suicide behaviors.

Methods

A total of 130 Veterans admitted to the psychiatric unit for suicide ideation or attempts will be randomized to active TMS plus BCBT or to sham TMS plus BCBT. Participants will be assessed at baseline, post-treatment, and six and 12 months post-hospital discharge.

Efficacy of each program will be determined by examining a primary suicide composite outcome and several secondary outcomes, including suicide attempt, time to first attempt, number of re-hospitalizations and severity, and severity of suicide ideation. Analyses will help identify the types of patients who received the most benefit from the addition of TMS to BCBT for suicide.

Findings are not yet available.

Anticipated Impact

If successful, this study will result in a combined treatment to decrease suicide ideation and related behaviors. Next steps could include dissemination and implementation throughout VA in coordination with local VISN and VA operations partners, and submittal of a partnered QUERI application.

Principal Investigators

Jennifer Primack, PhD (left) and Noah Philip, MD (right)

Jennifer Primack, PhD, is part of HSR&D’s Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans in Providence, RI. Noah Philip, MD, is part of the VA Providence Healthcare System as section chief of Psychiatric Neuromodulation and lead for mental health research at the VA RR&D Center for Neurorestoration and Neurotechnology.

Recent related publications by these investigators

Barredo J, Bozzay ML, Primack JM, et al. Translating interventional neuroscience to suicide: It’s about time. Biological Psychiatry. June 1, 2021;89(11):1073–1083.

View the study abstract.

³ 2022 National Veteran Suicide Prevention Annual Report, VA Suicide Prevention, Office of Mental Health and Suicide Prevention, September 2022

⁴ 2022 National Veteran Suicide Prevention Annual Report, VA Suicide Prevention, Office of Mental Health and Suicide Prevention, September 2022