Does prolonged exposure increase suicide risk? Results from an active duty military sample

Brown, Lily A.; McLean, Carmen P.; Zang, Yong; Zandberg, Laurie J.; Mintz, Jim; Yarvis, Jeffrey S.; Litz, Brett T.; Peterson, Alan L.; Bryan, Craig J.; Fina, Brooke A; Petersen, Julie M.; Dondanville, Katherine A.; Roache, John D.; Young‐McCaughan, Stacey; Foa, Edna B.

doi:10.1016/j.brat.2019.04.003

Cited by 27 publications

(21 citation statements)

References 28 publications

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“…Second, changes in PTSD symptom severity were significantly predictive of changes in suicidal ideation. Because PTSD is a notable risk factor for suicidal ideation (Gradus, 2018; Holliday, Monteith, et al., 2018), we expected that PTSD treatment would decrease PTSD symptoms and suicidal ideation, as has been found in previous studies (Brown et al., 2019; Cox et al., 2016; Norr et al., 2018; Stayton et al., 2019).…”

Section: Discussionmentioning

confidence: 82%

Residential Cognitive Processing Therapy Decreases Suicidality by Reducing Perceived Burdensomeness in Veterans with Posttraumatic Stress Disorder

Blain

Pukay‐Martin

Martin

et al. 2020

Journal of Traumatic Stress

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The interpersonal theory of suicide (Joiner, 2005) may help explain high suicide rates among veterans with posttraumatic stress disorder (PTSD). It suggests that suicidal ideation results from believing that one is a burden on others (i.e., perceived burdensomeness) and does not belong among family, friends, or other social groups (i.e., thwarted belongingness). Evidence‐based PTSD treatments, including cognitive processing therapy (CPT), decrease suicidal ideation, potentially through changes in these two theory constructs. The current study examined whether (a) changes in PTSD severity and suicidal ideation and (b) changes in negative cognitions about self and suicidal ideation were indirectly associated through changes in perceived burdensomeness and thwarted belongingness across PTSD treatment. Participants (N = 107) were veterans in a residential treatment program who were diagnosed with full or subthreshold PTSD and received CPT. Changes in PTSD symptom severity and negative cognitions about self predicted changes in suicidal ideation, B = 0.18, p < .001 and B = 0.50, p < .001, respectively. Changes in PTSD symptom severity and negative cognitions about self were indirectly associated with suicidal ideation through changes in perceived burdensomeness, B = 0.16, 95% CI [0.07, 0.25]; B = 0.27, 95% CI [0.05, 0.50], but not thwarted belongingness, B = −0.002; 95% CI [−0.06, 0.06]; B = 0.06, 95% CI [−0.12, 0.21] in separate models. These findings suggest that residential CPT may be uniquely equipped to decrease suicidality by restructuring negative beliefs, including perceptions of being a burden on others, and/or by alleviating the objective burden of PTSD.

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Section: Discussionmentioning

confidence: 82%

Residential Cognitive Processing Therapy Decreases Suicidality by Reducing Perceived Burdensomeness in Veterans with Posttraumatic Stress Disorder

Blain

Pukay‐Martin

Martin

et al. 2020

Journal of Traumatic Stress

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“…Current gold-standard treatments for PTSD, such prolonged exposure (PE) and cognitive processing therapy (CPT), as well as interventions for MDD, such as cognitive behavioral therapy (CBT) and acceptance and commitment therapy for depression (ACT-D), may also help reduce SI. [64][65][66][67] For instance, in a study that examined changes in SI during PTSD treatment and up to 5 to 10 years posttreatment, results suggested that both PE and CPT were associated with a reduction in SI. 64 Further research is needed to examine the mechanisms underlying the relationship between PTSD and MDD treatment and changes in SI.…”

Section: Discussionmentioning

confidence: 99%

Purpose in Life and Conscientiousness Protect Against the Development of Suicidal Ideation in U.S. Military Veterans With PTSD and MDD: Results From the National Health and Resilience in Veterans Study

et al. 2019

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Background:Although several studies have examined risk factors for suicidal ideation among veterans, little is known about risk and protective factors for suicidal ideation in high-risk veteran samples. Thus, this study examined a broad range of risk and protective factors associated with the development of suicidal ideation in a high-risk sample of U.S. veterans who screened positive for current posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD). Methods: Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative, prospective cohort study of U.S. veterans. Veterans completed self-report measures to screen for PTSD and MDD and to assess for risk and protective factors. The sample included 222 veterans with PTSD and/or MDD who did not endorse suicidal ideation at baseline and completed at least one assessment over a seven-year follow-up period. A multivariable binary logistic regression analysis was conducted to examine baseline factors associated with incident suicidal ideation. Results: Nearly one in three (27.1%) of veterans with PTSD and/or MDD developed suicidal ideation over the seven-year follow-up period. Non-Caucasian race and lower scores on measures of purpose in life, conscientiousness, and frequency of religious service attendance were independently associated with incident suicidal ideation. Lower purpose in life (52.3%) and conscientiousness (33.2%) explained the vast majority of variance in incident suicidal ideation. Conclusion: Nearly 30% of veterans with PTSD and/or MDD who did not endorse suicidal ideation at baseline developed suicidal ideation over a seven-year period. Prevention and treatment efforts designed to bolster purpose in life and conscientiousness may help mitigate risk for suicidal ideation in this high-risk population.

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“…Veterans enrolled in PE exhibited significant reductions in SI over the course of treatment, and these changes in PTSD were predictive of future changes in SI for this sample (Cox et al, 2016). Additionally, PE resulted in significant reductions in SI over the course of both massed and traditional PE formats (Brown et al, 2019a). 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).…”

Section: Ptsd and Suicidal Ideationmentioning

confidence: 99%

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

Martin¹,

Coe²,

Pease³

et al. 2023

Psychological Services

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Suicidal ideation (SI) is a highly prevalent public health issue in the veteran population and is increasingly common in veterans who are diagnosed with other mental health conditions, such as posttraumatic stress disorder (PTSD; U.S. Department of Veterans Affairs, 2020). The present study has an initial aim of examining changes in SI over treatment, and it is hypothesized that SI will decrease across PTSD treatments. A second aim is to examine the association of SI status with PTSD symptoms across treatment, and it is hypothesized that PTSD symptomatology will decrease at similar rates over the course of treatment for those who did and did not endorse SI at pretreatment. Participants included 717 (86.3% male) veterans who participated in outpatient treatment within a Veterans Affairs Post Traumatic Stress Disorder (VA PTSD) specialty clinic between July 2014 and December 2017. Descriptive analyses found that 37.2% of veterans endorsed SI at pretreatment, while 18.6% endorsed SI at posttreatment. The relationship between pre-and posttreatment SI was significant, χ 2 (1, N = 247) = 23.77, p < .001. A significant proportion of veterans who endorsed SI at pretreatment no longer endorsed SI at posttreatment (64.7%). There were no differences in changes in PTSD Checklist for DSM-5 (PCL-5) scores across treatment for those with and without SI at pretreatment. While those who endorsed SI at pretreatment had higher PCL-5 scores throughout treatment, they experienced a similar rate of improvement in symptoms as those without SI at pretreatment. This finding suggests that the presence of SI does not reduce the effectiveness of PTSD treatment. Limitations include the use of a single-item measure of SI, lack of adequate power to detect difference among treatments, and a crosssectional design. Clinical and research implications are discussed. Impact StatementStudy findings contribute to the understanding of suicidal ideation in Veterans, an extremely concerning public health issue. Significantly fewer Veterans endorsed suicidal ideation following completion of an evidence-based psychotherapy for PTSD. Additionally, there were no significant differences in the change in PTSD symptoms for Veterans who did and did not endorse suicidal ideation at pretreatment, lending support that both groups benefitted equally well from EBPs for PTSD.

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Does prolonged exposure increase suicide risk? Results from an active duty military sample

Cited by 27 publications

References 28 publications

Residential Cognitive Processing Therapy Decreases Suicidality by Reducing Perceived Burdensomeness in Veterans with Posttraumatic Stress Disorder

Residential Cognitive Processing Therapy Decreases Suicidality by Reducing Perceived Burdensomeness in Veterans with Posttraumatic Stress Disorder

Purpose in Life and Conscientiousness Protect Against the Development of Suicidal Ideation in U.S. Military Veterans With PTSD and MDD: Results From the National Health and Resilience in Veterans Study

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

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