Effectiveness of Complementary and Integrative Approaches in Promoting Engagement and Overall Wellness Toward Suicide Prevention in Veterans

Abstract

Objective: Suicide is a major public health problem, specifically among U.S. veterans, who do not consistently engage in mental health services, often citing stigma as a barrier. Complementary and Integrative Health (CIH) interventions are promising alternatives in promoting patient engagement and further, they may play a critical role in transitioning people into mental health care. Toward this goal, the Resilience and Wellness Center (RWC) was developed to break through the stigma barrier by addressing risk factors of suicide through multimodal CIH interventions via cohort design, promoting social connectedness and accountability among participants. Design: This is a program evaluation study at a large urban VA medical center, where assessments were evaluated from pre- to post-program completion to determine the effectiveness of an intensive multimodal CIH 4-week group outpatient intervention for suicide prevention. Outcome measures: Primary outcomes measured included group connectedness, severity of depression and hopelessness symptoms, suicidal ideation, sleep quality, and diet. Secondary outcomes included measures of post-traumatic stress disorder (PTSD), generalized anxiety severity stress/coping skills, pain, and fatigue. Results: The RWC showed high participant engagement, with an 84%–95% attendance engagement rate depending on suicide risk history. Data from 15 cohorts ( N = 126) demonstrate favorable outcomes associated with participation in this comprehensive program, as evidenced by a reduction in suicidal ideation, depression, and hopelessness, but not sleep quality and diet. In addition, in a subset of veterans with a history of suicidal ideation or attempt, significant improvements were noted in pain, PTSD/anxiety symptoms, and stress coping measures. Conclusions: The RWC shows that an intensive complement of CIH interventions is associated with a significant improvement with high veteran engagement. Findings from this program evaluation study can be used to aid health care systems and their providers in determining whether or not to utilize such multimodal CIH integrated interventions as an effective treatment for at-risk populations as a part of suicide prevention efforts.

The Effectiveness and Safety of Acupuncture on Suicidal Behavior: A Systematic Review

“…In the second step, through a full-text review, nine articles that did not meet the inclusion criteria were excluded. The reasons for the papers excluded in the second step are as follows: a case study of self-injury after acupuncture [ 26 ], a letter to the editor without clinical data [ 27 ], four observational studies [ 28 , 29 , 30 , 31 ], and three not reporting suicidal behaviors as their outcomes [ 32 , 33 , 34 ]. Finally, eight studies in nine articles [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ] were included in this review by the two-step selection process.…”

“…Additionally, more than half of the studies [ 35 , 36 , 37 , 38 , 43 ] included in this systematic review were conducted in China, and the others [ 39 , 40 , 41 ] were conducted in Iran. Although there are some observational studies suggesting the clinical benefits of acupuncture on suicidal behavior conducted in other countries [ 28 , 29 , 30 , 31 ], interventional studies targeting various ethnicities are needed to increase the possibility of a generalization. Finally, although acupuncture is considered a safe non-pharmacological treatment [ 59 ], the fact that safety data of acupuncture was reported in only three [ 35 , 36 , 37 ] of the studies included in this review is acknowledged as a methodological and ethical limitation.…”

“…Second, given the importance of multidisciplinary approaches to suicide prevention, acupuncture also deserves to be investigated for its effectiveness and efficiency in other multicomponent suicide prevention programs. For example, the effectiveness of already introduced CIM services, including acupuncture, on the suicidal behavior of mentally vulnerable groups, such as veterans, could be investigated [ 31 ]. Third, some important factors, such as an individual’s experience of the acupuncture procedure, perceived effectiveness of acupuncture, and practitioner–patient communication [ 15 ], that potentially influence acupuncture procedures on suicidal behavior, could be further investigated.…”

Facilitators and barriers for implementing the integrated behavioural health care model in the USA: An integrative review

“…2018; Lake & Turner 2017; Patel & Chatterji 2015; Vitale et al . 2021). For example, in the United States alone, the 2018 national mental health expenditures amounted to $213.3 billion, with $31 billion due to loss of work productivity (CDC 2018; Falconer et al .…”

Delivery of Telehealth Complementary and Integrated Health Interventions Improves Mental Health and Overall Wellness to Broaden Veterans' Access to Care

“… 1 , 2 In previous study, the authors have shown that in-person programming using intensive multimodal CIH interventions resulted in significant reduction in suicidal ideation and associated mental health risk factors, and had high Veteran engagement. 3 With the emergence of the COVID-19 pandemic, the in-person multimodal CIH intervention was pivoted to a virtual delivery of care, and in this program evaluation study the authors set out to see whether the virtual mode of delivery was similarly effective.…”