Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1074 — Two Promising Evidence-Based Interventions for Suicide Prevention among Veterans with TBI

Lead/Presenter: Lisa Brenner
All Authors: Brenner LA (Rocky Mountain MIRECC) Hoffberg AS (Rocky Mountain MIRECC) Matarazzo BB (Rocky Mountain MIRECC) Barnes SM (Rocky Mountain MIRECC) Monteith LL (Rocky Mountain MIRECC) Gerard G (Rocky Mountain MIRECC) Forster JE (Rocky Mountain MIRECC)

Objectives:
US Veterans with traumatic brain injury (TBI) have higher suicide rates than members of the general Veteran population. A partnership was established between the Liverpool Brain Injury Rehabilitation Unit and the Rocky Mountain Mental Illness Research, Education, and Clinical Center to adapt and evaluate two cognitive behavioral group therapies (CBT) for Veterans with moderate to severe TBI and current hopelessness. The first intervention, Window to Hope (WtoH), was culturally adapted from the original developed in Australia. The second was a novel intervention employing Problem Solving Therapy and Safety Planning for Suicide Prevention (PST-SP).

Methods:
WtoH: Using a waitlist control design, forty-four Veterans with a history of moderate to severe TBI and significant hopelessness (Beck Hopelessness Scale of 9 or greater) were randomized to intervention (10 week group therapy) or waitlist groups. Data was collected at three time points to facilitate evaluation of the intervention for both the intervention and waitlist groups. PST-SP: Following treatment development, 16 Veterans with moderate-severe TBI and BHS > 4 participated in an acceptability and feasibility pilot study.

Results:
Feasibility of both interventions was supported by high attendance and low attrition. Quantitative data supported the acceptability of both interventions [WtoH RCT (n = 33): mean CSQ-8 = 27.8, SD = 4.3; PST-SP (n = 13): mean CSQ-8 = 27.8, SD = 4.78]. Qualitative results also supported the acceptability and feasibility of both interventions. RCT participants in the WtoH condition reported clinically and statistically significant decreases in hopelessness compared to those in the waitlist condition, after adjusting for baseline differences.

Implications:
Findings support the acceptability and feasibility of delivering WtoH and PST-SP to Veterans with moderate to severe TBI. Data from the WtoH RCT supported its efficacy for reducing hopelessness, a significant risk factor for suicide. Limitations included small sample size and variability in reported symptoms.

Impacts:
WtoH now has two small RCTs providing consistent preliminary evidence supporting its efficacy, and shows promise to fill a critical gap in providing evidence-based suicide prevention care for Veterans with a history of TBI. PST-SP has been shown to be feasible and acceptable in this pilot study, and future randomized studies should be completed to evaluate its efficacy.