Reducing Suicide Risk in Older Veterans Using Problem Solving Therapy

Launched by VA OFFICE OF RESEARCH AND DEVELOPMENT · Feb 17, 2021

Keywords

ClinConnect Summary

This clinical trial is studying a type of therapy called Problem Solving Therapy to help reduce the risk of suicide among older veterans dealing with issues like depression, anxiety, and PTSD. Researchers want to see if this therapy, combined with standard suicide safety planning, is more effective than the usual care provided by the Veterans Affairs system. The goal is to help veterans find better ways to cope with their feelings and challenges, especially those who may have difficulty with daily tasks or decision-making.

To participate in the trial, you need to be at least 55 years old and have had thoughts of suicide in the past month, but not be in immediate danger of acting on those thoughts. You should also have a diagnosis of a depressive disorder, anxiety disorder, or PTSD. Participants will receive either the new therapy or the usual care and will have regular check-ins to see how they're doing. It's important to know that this study aims to improve mental health support for older veterans and has the potential to make a positive difference in their lives.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • \>= 55 years old
• • SI (past month) on the C-SSRS
• • No SI or imminent risk (will be excluded)
• • Eligibility now includes non-specific active suicidal thoughts to active SI with some planning (on C-SSRS item 3: "Have you been thinking about how you might do this") and/or some intent to act (on C-SSRS item 4: "Have you had these thoughts and had some intention of acting on them?") provided that those endorsing item 4 have an established relationship with a psychiatrist aware of this intent level (who is not also performing psychotherapy)
• • Those endorsing C-SSRS item 5: "Do you intend to carry out this plan?" would be considered at imminent risk and excluded
• • Presence of DSM-5 depressive disorder or anxiety disorder, specified or unspecified, or PTSD or subthreshold PTSD.
• • No diagnosis of dementia; evidence that cognitive impairment is not indicative of possible dementia based on a negative cognitive telephone screen (\<10 errors on the Blessed cognitive screen)
• • No diagnosis on MINI or medical record for psychotic symptoms or disorders, bipolar disorder, or severe OCD (mild or moderate OCD will be eligible)
• • No history of head injury past 12 months
• • No severe or unstable chronic medical illness or other severe or unstable respiratory, cardiovascular, neurologic, hepatic, hematopoietic, gastrointestinal or metabolic dysfunction
• • AUDIT Total score \<15 for men or \<13 for women (no current alcohol use disorder)
• • No substance use disorder of any type for illicit substances, no moderate or severe substance use disorder for cannabis/marijuana - on the MINI.
• • No prominent homicidal ideation
• • English language proficiency to engage in treatment
• • Sensory abilities sufficiently intact to engage in assessment and treatment
• • Not currently enrolled in individual psychotherapy for a mental health issue. Participants who are receiving mental health care are eligible if their current care includes treatment from a psychiatrist, supportive therapy, peer counseling or support, or participating in psychoeducational groups.
• • No current prescription for anti-psychotics if prescribed for a psychotic disorder
• • Anti-psychotics for depression without psychosis are eligible
• • Psychotropic medications (e.g., SSRIs) are also eligible
• Exclusion Criteria:
• • \< 55 years old
• • No SI (past month) or imminent risk on the C-SSRS will be excluded. Those endorsing C-SSRS item 5: "Do you intend to carry out this plan?" would be considered at imminent risk and excluded
• • No DSM-5 depressive disorder or anxiety disorder, or PTSD or subthreshold PTSD
• • Diagnosis of dementia; evidence that cognitive impairment is indicative of possible dementia based on a positive cognitive telephone screen (\>=10 errors on the Blessed cognitive screen)
• • Diagnosis on MINI or medical record for psychotic symptoms or disorders, bipolar disorder, or severe OCD (mild or moderate OCD will be eligible)
• • History of head injury past 12 months
• • Severe or unstable chronic medical illness or other severe or unstable respiratory, cardiovascular, neurologic, hepatic, hematopoietic, gastrointestinal or metabolic dysfunction
• • AUDIT Total score \>14 for men or \>12 for women (no current alcohol use disorder)
• • Substance use disorder of any type for illicit substances, moderate or severe substance use disorder for cannabis/marijuana - on the MINI.
• • Prominent homicidal ideation
• • Lacking English language proficiency to engage in treatment
• • Sensory abilities not sufficiently intact to engage in assessment and treatment
• • Currently enrolled in individual psychotherapy for a mental health issue. Participants who are receiving mental health care are eligible if their current care includes treatment from a psychiatrist, supportive therapy, peer counseling or support, or participating in psychoeducational groups.
• • Current prescription for anti-psychotics if prescribed for a psychotic disorder, and not prescribed for depression without psychosis