Study Shows Brief Cognitive Behavioral Therapy Reduces Suicidal Ideation among Veterans with Chronic Illness
BACKGROUND:
Individuals with chronic medical illness and comorbid mental health disorders are at particular risk for suicide in primary care settings. Engaging these individuals in mental healthcare in the primary care setting is one potential avenue to reduce suicide by increasing access to critical mental health services. Brief cognitive behavioral therapy (bCBT) intervention delivered by VA mental health providers in primary care settings is effective for depression, anxiety, and improves physical health quality of life. Investigators in the current study used data from a VA HSR&D trial to determine the effect of bCBT on suicidal ideation among Veterans with cardiopulmonary chronic illness receiving mental health treatment in a VA primary care setting. Veterans were randomized to either bCBT (n=180) or enhanced usual care (EUC) (n=122). All participants endorsed elevated depression or anxiety symptoms, and the majority met criteria for a diagnosis of depressive or anxiety disorders. In addition, 27% endorsed suicidal ideation at baseline. The primary outcome was suicidal ideation, which was measured at baseline (i.e., pretreatment), posttreatment (4-month follow-up), and at 8 and 12 months.
FINDINGS:
- bCBT in primary care reduced suicidal ideation in Veterans with chronic medical illness. Veterans in the bCBT group were less likely to have high suicidal ideation than Veterans in the EUC group post-treatment and at 8-month follow-up after accounting for baseline suicidal ideation.
- The EUC group did not show any change in suicidal ideation from baseline to 4 or 8 months, but did indicate a reduction in high suicidal ideation at 12 months when compared with baseline within the same group.
IMPLICATIONS:
Results suggest that exposure to a brief evidence-based psychotherapy intervention in primary care may significantly reduce distress and suicidal ideation over a prolonged period of time, potentially reducing future suicide-related distress and/or attempts among a high-risk Veteran population.
LIMITATIONS:
- Veterans with substance use disorder, which is known to increase risk of suicide among those with elevated depression, anxiety, and medical illness were referred for specialty mental health services outside the primary care setting so were not part of this study.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 09-088). Drs. Ecker, Sansgiry, Fletcher, Hundt, Petersen, Kauth, Kunik, and Cully are part of HSR&D's Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX.
Ecker A, Johnson A, Sansgiry S, Fletcher T, Hundt N, Petersen N, Sweeney A, Chaison A, York-Ward K, Kauth M, Kunik M, and Cully J. Brief Cognitive Behavioral Therapy Reduces Suicidal Ideation in Veterans with Chronic Illnesses. General Hospital Psychiatry. February 8, 2019; Epub ahead of print.
