Crisis response planning reduces suicidal ideation among US military members, veterans
Click Here to Manage Email Alerts
Key takeaways:
- Crisis response planning more reliably improved suicidal ideation and PTSD symptoms compared with safety planning.
- There were fewer suicide attempts in the crisis response planning group.
Crisis response planning, a therapist-guided treatment for suicidal ideation, significantly reduced symptoms of suicidal ideation among U.S. military personnel and veterans, according to a study published in Journal of Anxiety Disorders.
“This study shows that crisis response planning can rapidly reduce suicide risk. It is the first study to prove this technique works when used during massed therapy for PTSD,” Craig J. Bryan, PsyD, ABPP, clinical psychologist, director of the division of recovery and resilience at The Ohio State University Wexner Medical Center, said in a related university press release.
The pragmatic parallel-arm randomized effectiveness study included 157 U.S. military personnel and veterans who met at least three of four symptom criteria for PTSD. Researchers randomly assigned the participants to one of two suicide risk interventions upon intake: a self-guided safety plan (SP; n = 81; mean age, 45.9 years; 63% men) or crisis response planning (CRP) with guidance from a therapist (n = 76; mean age, 48.3 years; 84.2% men).
Researchers directed participants in the SP group to handwrite their safety plan to include warning signs of a crisis and coping strategies, among other elements, whereas those in the CRP group created a personalized plan for responding to emotional distress and suicidal crises following a collaborative and interactive discussion with a therapist. All participants then received 10 daily 1-hour sessions of massed cognitive processing therapy.
Severity of suicidal ideation — evaluated with the 19-item Scale for Suicide Ideation (SSI), for which higher scores indicated more severe symptoms — served as the study’s primary outcome. Secondary outcomes included reported suicide attempts and severity of PTSD symptoms based on the National Stressful Events Survey PTSD Short Scale (NSESS-PTSD) where higher scores indicated more severe symptoms.
The researchers defined reliable improvement in symptoms as an SSI score decrease of at least 5.5 points and an NSESS-PTSD score decrease of at least 3.5 points.
At baseline, the mean SSI score was 6.4 (standard deviation [SD] = 7.7; range, 0-19), and the mean NSESS-PTSD score was 26.5 (SD = 7.2; range, 5-36). Seventy-five (47.8%) participants reported active (n = 51, 32.5%) and/or passive (n = 60, 38.2%) suicidal ideation.
Among the 51 participants who reported active suicidal ideation, CRP reduced symptoms more than SP, with a greater difference seen during the active treatment phase (P < .001). SSI scores decreased more with CRP than SP halfway through treatment (P = .004) and after treatment (P = .037).
A larger portion of participants in the CRP group showed reliable improvement in SSI scores than the SP group at treatment midpoint (60% vs. 47.1%), with similar rates seen at 6 months (62.5% vs. 57.9%) and 12 months (54.5% vs. 56.3%).
Following treatment, however, researchers noted that SSI scores remained unchanged in the SP group, but they increased in the CRP group at 6 months (P = .022) and 12 months (P = .008), becoming comparable to those of the SP group.
Among 106 participants denying suicidal ideation at baseline, fewer of those in the CRP group than the SP group reported new-onset suicidal ideation at any point, although the difference did not reach statistical significance (8.5% vs. 11.9%; OR = 0.69; 95% CI, 0.19-2.52). Researchers also noted a reduction in PTSD symptoms for these patients from both treatment groups, but there were no significant differences in mean NSESS-PTSD scores between treatment groups at any point.
CRP also showed greater improvement in PTSD symptoms among participants who reported active suicidal ideation (P < .001).
Halfway through treatment, a smaller proportion of participants in the CRP group showed reliable improvement in NSESS-PTSD scores than the SP group (47.6% vs. 64.7%), a trend that reversed by the end of treatment (85% vs. 62.5%).
Among participants who reported active suicidal ideation at baseline, two participants from the CRP group made three suicide attempts after treatment, and three participants in the SP group made one suicide attempt during treatment and six attempts after treatment. Among those who did not report active suicidal ideation, one participant from each group attempted suicide after treatment.
“CRP, a brief safety planning-type intervention, is effective for rapidly reducing suicidal ideation among patients receiving massed therapy for PTSD in outpatient clinical settings,” Bryan and colleagues wrote. “CRP may also reduce suicide attempts and prevent new-onset suicidal ideation, though additional research with larger samples is needed to confirm this possibility.”
Reference:
- Study: New treatment method helps reduce suicide among military and veterans. https://wexnermedical.osu.edu/mediaroom/pressreleaselisting/study-new--treatment-method-helps-reduce-suicide-among-military-and-veterans. Published Feb. 14, 2024. Accessed Feb. 26, 2024.