A Randomized Trial of Dialectical Behavior Therapy in High-Risk Suicidal Veterans
Abstract
OBJECTIVE: Despite advances in suicide prevention implemented throughout the US Department of Veterans Affairs (VA) including the hiring of Suicide Prevention Coordinators (SPCs) at every VA hospital, enhanced monitoring, and the availability of 24-hour crisis hotline services, suicide by veterans remains a critical problem affecting 20 veterans daily. Few empirically based treatment strategies for suicide prevention for postdeployment military personnel exist. This study aimed to test whether dialectical behavior therapy (DBT), one of the few psychosocial treatments with proven efficacy in diminishing suicidal behavior in individuals with personality disorder, can be applied to veterans irrespective of personality diagnosis. METHODS: From January 2010 to December 2014, 91 nonpsychotic veterans at high risk for suicide (61 men, 30 women) were randomly assigned to a 6-month treatment trial at a veterans' medical center comparing standard DBT to treatment as usual (TAU) and followed for 6 months after trial completion. Primary outcome was suicide attempts, measured with the Columbia-Suicide Severity Rating Scale, and secondary outcomes were suicide ideation, depression, hopelessness, and anxiety. There were no exclusions pertaining to substance abuse, homelessness, or medical comorbidity. RESULTS: Both DBT and TAU resulted in improvements in suicidal ideation, depression, and anxiety during the course of the 6-month treatment trial that did not differ between treatment arms. Survival analyses for suicide attempts and hospitalizations did not differ between treatment arms. However, DBT subjects utilized significantly more individual mental health services than TAU subjects (28.5 ± 19.6 vs 14.7 ± 10.9, F₁,₇₇ = 11.60, P = .001). CONCLUSIONS: This study is the first to examine 6-month DBT in a mostly male, veteran population. Increased mental health treatment service delivery, which included enhanced monitoring, outreach, and availability of a designated SPC, did not yield statistically significant differences in outcome for veterans at risk for suicide in TAU as compared to the DBT treatment arm. However, both treatments had difficulty with initial engagement post-hospitalization. Future studies examining possible sex differences and strategies to boost retention in difficult-to-engage, homeless, and substance-abusing populations are indicated. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02462694.
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- Authors
- Goodman, M., Banthin, D., Blair, N. J., Mascitelli, K. A., Wilsnack, J., Chen, J., Messenger, J. W., Perez-Rodriguez, M. M., Triebwasser, J., Koenigsberg, H. W., Goetz, R. R., Hazlett, E. A., & New, A. S.
- Affiliations
- New York/New Jersey VA Health Care Network (US)
- James J. Peters VA Medical Center (US)
- New York State Psychiatric Institute (US)
- Icahn School of Medicine at Mount Sinai (US)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2016-10-25
- Volume
- 77
- Issue
- 12
- Pages
- e1591-e1600
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2538574690
- Cited by
- 75
- References
- 0
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 9 · 2023: 13 · 2022: 11 · 2021: 11 · 2020: 5 · 2019: 6 · 2018: 3 · 2017: 1 · 2016: 2
- FWCI
- 5.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- dialectical behavior therapy, suicide prevention, veterans, suicide attempts, suicidal ideation, depression, anxiety, hopelessness, treatment engagement, treatment retention, psychosocial interventions
- MeSH terms
- Adult, Anxiety, Behavior Therapy, Depression, Female, Follow-Up Studies, Humans, Male, Mental Health Services, Middle Aged, Outcome and Process Assessment, Health Care, Psychotherapy, Group, Suicide, Attempted, Veterans, Suicidal Ideation, Hope
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