1 - (SYM 35) Suicide Prevention for Older Military Veterans: A Pilot Randomized Controlled Trial of Problem Solving Therapy for Reducing Suicidal Ideation and Increasing Reasons for Living

More than half of military Veteran suicides are in the 55+ age group, highlighting a critical need in older Veterans (US Department of Veterans Affairs [VA], 2022). Despite this need, there is little research on psychotherapies for preventing late life suicide in Veterans. This study examined the efficacy of Problem Solving Therapy (PST) for reducing suicide ideation (SI), increasing reasons for living (RFL), and reducing functional disability in older Veterans. PST has efficacy for older adults with mental health disorders, especially depression with executive dysfunction (e.g., Alexopoulos et al., 2011). Relevant to suicide risk, emotion-centered PST (EC-PST) builds patient skills in problem-solving and includes “toolkits” to reduce impulsive behaviors, intense negative emotions, and feelings of hopelessness. A VA multi-site randomized controlled trial compared safety planning (enhanced usual care; EUC) to EC-PST + EUC to determine if EC-PST provides benefits above EUC for reducing SI severity, increasing RFL, and reducing functional disability in Veterans ages 55+.

Eligible Veterans had active, non-imminent past-month SI and significant symptoms of a mood disorder, anxiety disorder, and/or posttraumatic stress disorder (PTSD).  Seventy-one Veterans were randomized to six sessions of EUC (n = 36) or EC-PST + EUC (n = 35). Study activities were via telephone. Results from linear mixed effects models showed a significant decrease in SI (Geriatric Suicide Ideation Scale total score) at post treatment in the EC-PST + EUC group (est = -13.01, SE=3.08, 95% CI:-19.19, -6.82, p< .0001; ES: -0.65, ES 95% CI: -0.96, -0.35), but not for the EUC group (p=.08); the difference between the two conditions was not statistically significant (est = -7.44, SE=4.39, 95% CI -16.25, 1.36, p = .10). For Reasons For Living, no significant within- or between-group differences were found (ps > .05). The EC-PST + EUC group showed a significant decrease in functional disability (WHO Disability Assessment Schedule 2.0 12-item total score) at post treatment (est = -2.26, SE=1.12, 95% CI: -4.51, -0.01, p = .049, ES: -0.23, ES 95% CI: -0.45, -0.01), but the EUC group showed no change in disability (p=.38); EC-PST + EUC had a greater reduction in disability than EUC (est = -3.23, SE=1.56, 95% CI -6.35, -0.10, p = .043, ES: -0.34, 95% CI: -0.67, -0.01). Post-treatment feedback about participant satisfaction with the treatments will also be presented. Analyses support the added benefit of brief EC-PST for reducing suicidal ideation and functional impairment in older Veterans.