Individuals with posttraumatic stress disorder (PTSD) are at increased risk for suicidal thoughts and behaviors; however, clinicians often report apprehension about recommending trauma-focused therapy to patients with an increased risk of suicide. The present study aimed to evaluate the safety, tolerability, and response to cognitive processing therapy (CPT) among a sample of military veterans with PTSD and increased suicide risk. A secondary aim was to provide a clinically useful definition of high suicide risk. Chart review was used to classify the suicide risk level of 290 veterans who participated in CPT at a Veterans Affairs clinic. Treatment outcomes in veterans with different suicide risk levels were also gathered and compared. Over 50% (n = 155) of the sample demonstrated increased suicide risk, and 1.0% (n = 3) engaged in suicidal behavior after initiating treatment. To date, hospital records show no suicide deaths since 2016 among clinic patients who received CPT. Suicide risk level was not associated with CPT tolerability, and PTSD symptom change was equivalent across groups, ps = .085–.976. Veterans across groups reported clinically significant reductions in PTSD symptoms. The tested suicide risk categorization schemes performed similarly in differentiating the odds of CPT completion and PTSD symptom reduction. These results suggest that veterans with PTSD and an increased risk of suicide, including those with previous suicide attempts and current ideation, can tolerate and benefit from CPT. Additional variables must be considered to truly determine the acute and imminent suicide risk that would deem CPT to be contraindicated.

中文翻译：

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治疗有自杀风险的退伍军人：认知加工疗法的安全性、耐受性和结果的检查

患有创伤后应激障碍 (PTSD) 的人出现自杀念头和行为的风险增加；然而，临床医生经常报告担心向自杀风险增加的患者推荐以创伤为中心的治疗。本研究旨在评估一组患有 PTSD 且自杀风险增加的退伍军人样本对认知加工治疗 (CPT) 的安全性、耐受性和反应。次要目的是为高自杀风险提供临床有用的定义。图表审查用于对在退伍军人事务部诊所参加 CPT 的 290 名退伍军人的自杀风险等级进行分类。还收集并比较了具有不同自杀风险水平的退伍军人的治疗结果。超过 50% ( n= 155) 的样本表明自杀风险增加，1.0% ( n = 3) 在开始治疗后从事自杀行为。迄今为止，医院记录显示，自 2016 年以来，接受 CPT 的临床患者中没有自杀死亡。自杀风险水平与 CPT 耐受性无关，且各组 PTSD 症状变化相同，ps = .085–.976。各组的退伍军人报告说 PTSD 症状在临床上有显着减少。测试的自杀风险分类方案在区分 CPT 完成和 PTSD 症状减轻的几率方面表现相似。这些结果表明，患有 PTSD 和自杀风险增加的退伍军人，包括那些有过自杀企图和当前想法的退伍军人，可以忍受 CPT 并从中受益。必须考虑其他变量才能真正确定将 CPT 视为禁忌的急性和迫在眉睫的自杀风险。