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Background:Suicide in the military has become an increasingly problematic issue. Military suicide rates have risen over the last 15 years to exceed that of the normal population (Claussen and Knox, 2011). The objective of this study was to assess the degree to which components of the interpersonal theory of suicide (IPTS; Joiner et al 2005) vary as a function of brief cognitive behavioral therapy (BCBT) compared to treatment as usual (TAU). Specifically, this study hypothesized that BCBT would result in long-term (assessment at 12 months) reductions in two components of IPTS: thwarted belongingness (TB) and perceived burdensomeness (PB). It was hypothesized that these reductions would be greater than that seen in the control (TAU) condition.
Methods: This randomized clinical trial compared suicide treatment interventions. Participants with suicidal ideation (with intention to die) or a recent suicide attempt were randomly assigned to TAU or BCBT in addition to TAU. Therapists in the BCBT condition were trained and monitored for compliance (See Rudd et al, 2015). Participants were active-duty Army soldiers (N =127) at Ft. Carson, Colorado who were recruited from emergency room visits. Data from a subset of this sample (N= 40) were soldiers who completed measures at pre-test and at 12 months. Data were collected at military installation treatment clinics by treatment providers and investigators. The primary outcome measure used in this study was the Interpersonal Needs Questionnaire (INQ; Van Orden, Witte, Gordon, Bender & Joiner, 2008). The INQ has two subscales measuring TB and PB—both of which have been shown to have adequate psychometric properties and utility for predicting suicide risk in the military. Data were analyzed using repeated measures analysis of variance (ANOVA) comparing within subjects and between treatment group variations in the outcome measures.
Results: On PB, there was a significant main effect for treatment (BCBT Time 1: M = 18.30, SD = 12.67; Time 2: M = 14.22, SD = 11.31; TAU Time 1: M = 28.24, SD = 10.76; Time 2: M = 20.47, SD = 12.89; F (1, 3) = 8.96, p = .004). On TB, there was no significant main effect (F (1, 3) = 1.31, p = 0.26). However, BCBT (Time 1: M = 24.61, SD = 7.17; Time 2: M = 24.78, SD = 6.60) showed less overall levels of TB than TAU (Time 1: M = 25.82, SD = 7.43; Time 2: M = 27.76, SD= 7.98) at 12 -months, suggesting that this condition may lead to better overall outcomes on this variable.
Conclusions: There is an urgency to reduce death by suicide in the military together with the need to reduce risk factors for suicide among military service members. This study suggests that BCBT may benefit soldiers with serious suicide events and that BCBT may help reduce the risk factors proposed by the IPTS. Future research should undertake longitudinal analytic methods to account for attrition and increase statistical power.