August 2017

In this Issue: Suicide Prevention
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Mindfulness-Based Cognitive Therapy for Suicide Prevention

Feature Article

VA data show that 80% of non-fatal suicide attempts among Veterans occurred within four weeks of having had a VA healthcare visit, 40% of which were outpatient mental health visits. Moreover, despite VA's comprehensive suicide prevention efforts, VA data show that 11% of Veterans with one suicide attempt make a re-attempt within nine months. There is a clear need for new psychotherapeutic interventions for preventing suicide that are cost-efficient, patient-centered, and compatible with VA's existing suicide prevention efforts.

This ongoing randomized controlled trial will test an innovative psychotherapy: Mindfulness-Based Cognitive Therapy for Suicide (MBCT-S) combines cognitive behavioral techniques with mindfulness meditation to specifically target suicidal behavior. Investigators have been recruiting Veterans at high-risk for suicide, most of whom have had a history of suicide behavior. Specific study objectives include determining if MBCT-S is more effective than treatment as usual (TAU) in reducing:

• Suicide events (a broad range of suicide behaviors defined according to VA's Self-Directed Violence Classification System);
• Suicide attempts; and
• The severity of suicide ideation, depression and hopelessness.

The study intervention (MBCT-S) is a modification of Mindfulness-Based Cognitive Therapy (MBCT), an evidence-based practice developed for treating depression. MBCT-S incorporates the VA Safety Planning intervention and includes a transitional service delivery model that provides continuous treatment from inpatient to outpatient settings. Investigators will randomize 164 Veterans to receive either MBCT-S+TAU (n=82) or TAU only (n=82) in order to compare the adjunctive value of MBCT-S to VA's existing suicide prevention protocol. Study participants will receive a total of five assessments at: baseline, 5 weeks post-baseline, 10 weeks post-baseline (coinciding with MBCT-S treatment completion), 6-months post-baseline, and 12-months post-baseline.

Impact: This study has the potential to increase the range of cost-effective treatment alternatives for Veterans at risk of suicide. It also may initiate a new line of research addressing a key gap in suicide interventions. If effective, the therapy will enhance VA's existing array of suicide prevention strategies and reduce the number of Veterans who attempt or die of suicide.

Principal Investigator: Alejandro Interian, PhD, an HSR&D affiliate investigator, is part of the VA New Jersey Health Care System.

Mindfulness-Based Cognitive Therapy for Suicide Prevention project abstract