Courses of suicidal ideation among military veterans in residential treatment for posttraumatic stress disorder

Abstract

Background Suicidal thoughts are common among veterans with posttraumatic stress disorder (PTSD). The aim of this study was to examine the prevalence and correlates of four courses of suicidal (SI) among veterans receiving residential PTSD treatment. Methods A total of 1,807 veterans receiving residential PTSD treatment at Department of Veterans Affairs medical facilities who completed self‐report measures at admission and discharge were included. Results The prevalence of SI courses were No SI (33.6%), Remitted SI (23.0%), SI onset (6.0%), and Chronic SI (37.4%). There were group differences between the four SI courses in PTSD symptoms at baseline, magnitude of PTSD symptom change during treatment, race/ethnicity and baseline depression, substance use, physical functioning, and pain. Chronic SI was associated with highest baseline PTSD, depression, substance use, pain and worse physical functioning. Remitted SI course was associated with greatest pre‐posttreatment PTSD improvement, followed by No SI, Chronic SI, and SI Onset. Multinomial logistic regressions revealed that PTSD symptom improvement and baseline PTSD symptoms most consistently related to symptomatic SI courses compared to less symptomatic or No SI courses. Receipt of trauma‐focused psychotherapy (none, some, or adequate) and length of stay were not related to SI courses and did not differ between groups. Conclusions Findings indicate that treating PTSD symptoms could be impactful for reducing suicidal thoughts. Although many veterans had remitted or reduced severity of SI at discharge, a significant proportion of veterans reported SI at discharge (43.4%), potentially highlighting the need for suicide specific treatment interventions within the context of PTSD treatment.

Suicidal ideation in veterans enrolled in evidence-based psychotherapy for posttraumatic stress disorder.

“…This is consistent with other studies of veteran samples that have found SI to significantly decrease over the course of EBPs for PTSD (e.g., Stayton et al, 2019). Specifically, this is consistent with findings from a residential PTSD treatment program, which found that changes in PTSD symptomatology did not differ for those with differing severity levels of SI at pretreatment (Smith et al, 2020). The present study reflects a similar extension of these findings to an outpatient sample of veterans in PTSD treatment.…”

“…A recent study examined outpatient CPT and PE treatment together and found that SI significantly decreased over the course of these EBPs for PTSD and that PTSD symptom clusters were associated with changes in SI (Horwitz et al, 2019). Finally, similar results were found in a sample of veterans in residential treatment engaged in either CPT or PE, such that SI decreased over the course of treatment and PTSD symptoms were significantly associated with these decreases in SI (Smith et al, 2020). Overall, the literature shows that EBPs for PTSD result in significant reductions in suicidal ideation over the course of treatment in both outpatient and residential treatment settings.…”

“…CBCT is a couples-based PTSD treatment that has shown reductions in PTSD symptoms across all clusters when compared to waitlist (Macdonald et al, 2016). Not only have the PTSD EBPs been associated with significantly reduced PTSD symptoms in veteran (e.g., Monson et al, 2006; Stayton et al, 2019) and nonveteran (e.g., Gradus et al, 2013) samples, they have also shown reductions in comorbid symptoms of PTSD, such as depressive symptoms (e.g., Resick et al, 2017) and suicidal thoughts and/or behaviors (e.g., Bryan et al, 2018; Cox et al, 2016; Smith et al, 2020).…”

“…Additionally, few studies have examined changes in suicidal ideation across various EBPs (i.e., CPT, PE) for PTSD, and replication of these methods in different clinical settings with veterans who exhibit a variety of trauma types is warranted to determine how well previous findings generalize. One study (i.e., Smith et al, 2020) has examined differences in courses of SI across residential PTSD treatment; however, it is important to examine similar approaches in outpatient samples given differences in the severity of mental health symptoms in these settings (e.g., Horwitz et al, 2019).…”

Impact of residential PTSD treatment on suicide risk in veterans

“…There is limited research on evidence-based treatment for PTSD and its impact on suicidal thoughts and behaviors. A national study examined the prevalence and correlates of SI in a national sample of veterans in residential PTSD treatment and found an absence of SI among the majority of participants, although 43% still endorsed some level of suicidal ideation (Smith et al, 2020). Other studies found that treatment of PTSD in veterans could be associated with reductions in suicidal ideation (e.g., Stayton et al, 2019) in residential treatment.…”