Evaluating a Recovery-Oriented Intensive Outpatient Program for Veterans at Risk for Suicide
Abstract
Abstract.Background: Suicide is the 10th leading cause of death in the United States and suicide risk is elevated among military veterans. Risk for suicide is inherently transdiagnostic, complex, and multifaceted, which means a comprehensive psychotherapeutic approach to risk mitigation is required. Aims: Our aims were to summarize findings from an evaluation of an interdisciplinary, recovery-oriented intensive outpatient program (IR-IOP) that includes evidence-based suicide prevention stategies for veterans with varying psychiatric diagnoses who are at risk for suicide. Method: Veterans completed the Patient Health Questionnaire-9 and the Beck Scale for Suicide Ideation prior to and following their participation in the IR-IOP. Results: A significant decrease in the severity of suicide ideation was found between pre- and posttreatment. Limitations: This program evaluation utilized archival data and, as such, there was not a control group and posttreatment follow-up data were not collected. Conclusion: Preliminary findings suggest an IR-IOP for veterans with heterogenous psychiatric diagnoses utilizing a multifaceted psychotherapeutic approach to suicide prevention may be effective in reducing suicide ideation.
References
1991). Manual for the Beck scale for suicide ideation. San Antonio, TX: Psychological Corporation.
(1988). Scale for suicide ideation: Psychometric properties of a self-report version. Journal of Clinical Psychology, 44, 499–505. 10.1002/1097-4679(198807)44:4%3C499::AID-JCLP2270440404%3E3.0.CO;2-6
(2014). A review of multidisciplinary clinical practice guidelines in suicide prevention: Toward an emerging standard in suicide risk assessment and management, training and practice. Academic Psychiatry, 38, 585–592. 10.1007/s40596-014-0180-1
(2000). Risk factors for suicide in psychiatric outpatients: A 20-year prospective study. Journal of Consulting and Clinical Psychology, 68, 371. 10.1037/0022-006X.68.3.371
(2018). Suicide prevention in the military: A mechanistic perspective. Current Opinion in Psychology, 22, 27–32. 10.1016/j.copsyc.2017.07.022
(2016). The ebb and flow of the wish to live and the wish to die among suicidal military personnel. Journal of Affective Disorders, 202, 58–66. 10.1016/j.jad.2016.05.049
(Centers for Disease Control and Prevention . (2019). WISQARS: Leading causes of death. Retrieved from http://www.cdc.gov/injury/wisqars/leading_causes_death.html2014). Risks of all-cause and suicide mortality in mental disorders: A meta-review. World Psychiatry, 13, 153–160. 10.1002/wps.20128
(2007). An evaluation of crisis hotline outcomes part 2: Suicidal callers. Suicide and Life-Threatening Behavior, 37, 338–352. 10.1521/suli.2007.37.3.338
(2014). An examination of the relationship between anger and suicide risk through the lens of the interpersonal theory of suicide. Journal of Psychiatric Research, 50, 59–65. 10.1016/j.jpsychires.2013.12.005
(1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12. 10.1037//0022-006X.59.1.12
(2005). Why people die by suicide. Cambridge, MA: Harvard University Press.
(2013). A meaningful life is worth living: Meaning in life as a suicide resiliency factor. Psychiatry Research, 210, 934–939. 10.1016/j.psychres.2013.08.002
(2015). The three-step theory (3ST): A new theory of suicide rooted in the "ideation-to-action" framework. International Journal of Cognitive Therapy, 8, 114–129. 10.1521/ijct.2015.8.2.114
(2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. 10.1046/j.1525-1497.2001.016009606.x
(2013). Risk factors associated with suicide in current and former US military personnel. JAMA, 310, 496–506. 10.1001/jama.2013.65164
(2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757–766. 10.1001/archpsyc.63.7.757
(2016). Does suicidal ideation as measured by the PHQ-9 predict suicide among VA patients? Psychiatric Services, 67, 517–522. 10.1176/appi.ps.201500149
(2013). Suicide risk among US Service members after psychiatric hospitalization, 2001–2011. Psychiatric Services, 64, 626–629. 10.1176/appi.ps.201200413
(2017). Treating veterans with PTSD and borderline personality symptoms in a 12-week intensive outpatient setting: Findings from a pilot program. Journal of Traumatic Stress, 30, 178–181. 10.1002/jts.22174
(2018). The PHQ-9 Item 9 based screening for suicide risk: A validation study of the Patient Health Questionnaire (PHQ)− 9 Item 9 with the Columbia Suicide Severity Rating Scale (C-SSRS). Journal of Affective Disorders, 232, 34–40. 10.1016/j.jad.2018.02.045
(Office of Mental Health and Suicide Prevention . (2019). National veteran suicide prevention annual report. Retrieved from https://www.mentalhealth.va.gov/docs/data-sheets/2019/2019_National_Veteran_Suicide_Prevention_Annual_Report_508.pdf2002). Use of the Beck Scale for Suicide Ideation with psychiatric inpatients diagnosed with schizophrenia, schizoaffective, or bipolar disorders. Behaviour Research and Therapy, 40, 1071–1079. 10.1016/S0005-7967(02)00002-5
(2018). Mental health professionals' suicide risk assessment and management practices. Crisis, 39, 55–64. 10.1027/0227-5910/a000478
(2018). Valued living, life fulfillment, and suicide ideation among psychiatric inpatients: The mediating role of thwarted interpersonal needs. Journal of Contextual Behavioral Science, 7, 8–14. 10.1016/j.jcbs.2017.11.001
(2015). Brief cognitive-behavioral therapy effects on post-treatment suicide attempts in a military sample: Results of a randomized clinical trial with 2-year follow-up. American Journal of Psychiatry, 172, 441–449. 10.1176/appi.ajp.2014.14070843
(2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19, 256–264. 10.1016/j.cbpra.2011.01.00
(The Joint Commission . (2018). National patient safety goal for suicide prevention. R3 Report. Requirement, Rational, Reference: A complimentary publication of The Joint Commission, 18. Retrieved from https://www.jointcommission.org/assets/1/18/R3_18_Suicide_prevention_HAP_BHC_11_27_18_FINAL.pdfUS Department of Veterans Affairs . (2018). National strategy for preventing veteran suicide 2018-2018. Retrieved from https://www.mentalhealth.va.gov/suicide_prevention/docs/Office-of-Mental-Health-and-Suicide-Prevention-National-Strategy-for-Preventing-Veterans-Suicide.pdfUS Department of Veterans Affairs/Department of Defense . (2019). VA/DoD clinical practice guideline for the assessment and management of patients at risk for suicide. Retrieved from https://www.healthquality.va.gov/guidelines/MH/srb/VADoDSuicideRiskFullCPGFinal5088212019.pdf2010). The interpersonal theory of suicide. Psychological Review, 117, 575–600. 10.1037/a0018697
(2013). A model for therapeutic risk management of the suicidal patient. Journal of Psychiatric Practice, 19, 323–326. 10.1097/01.pra.0000432603.99211.e8
(2016). Suicide prevention strategies revisited: 10-year systematic review. The Lancet Psychiatry, 3, 646–659. 10.1016/S2215-0366(16)30030-X
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