Craig J. Bryan
Researchers found that suicide attempt rates were consistently low among U.S. army personnel receiving brief cognitive-behavioral therapy regardless of patient severity level, but significantly varied according to severity in patients receiving treatment as usual.
“Currently, it is not known whether suicide-specific treatments are differentially efficacious for patient subgroups with varying levels of suicide risk,” Craig J. Bryan, PsyD, of the National Center for Veterans Studies at the University of Utah, and colleagues wrote in Psychiatric Services. “Additional studies are needed to examine the relative efficacy of these treatments for a range of patient subgroups.”
Researchers conducted a secondary analysis of a randomized clinical trial that compared the efficacy of brief CBT and treatment as usual to prevent suicidal behaviors among 176 army personnel to determine the treatment effects among patients at different levels of suicide risk.
The investigators compared rates of suicide attempts during the 24-month follow-up across classes (low-, moderate- and high-risk) and treatment groups. Participants completed follow-up assessment interviews at 3, 6, 12, 18 and 24 months. Brief CBT included 12 individual sessions delivered in three phases: emotion regulation skills training, cognitive restructuring skills training and relapse prevention.
Bryan and colleagues identified 55 participants at low-risk for suicide, 40 at moderate-risk and 57 at high-risk. Although suicide attempt rates were consistent among participants receiving brief CBT across all classes (10% in low severity, 13% in moderate severity and 10% in high severity), the rates varied significantly across classes among patients receiving treatment as usual (21% in low severity, 8% in moderate severity and 41% in high severity), with the worst outcomes observed among those with high-severity levels of suicide risk.
Suicide attempt rates significantly varied among patients in the high-severity class (P = .007), but not in the low- or moderate-severity classes. Furthermore, participants considered low-risk who received treatment as usual experienced the next highest rate of suicide attempts during follow-up, whereas those in the moderate-severity class saw the lowest rate.
“More research is needed to understand how clinicians approach treatment with different patient subgroups under treatment-as-usual conditions,” Bryan and colleagues wrote. “Overall, the results reported here support the efficacy of brief CBT for patients spanning the full spectrum of suicide risk.” – by Savannah Demko
Disclosures: The authors report no relevant financial disclosures.