Reducing suicide risk in older veterans using problem solving therapy
Reducing Suicide Risk in Older Veterans With Mental Health Disorders Using Problem Solving Therapy
This study is testing if a phone-based problem solving therapy can help older veterans with depression, anxiety, or PTSD who are having suicidal thoughts feel better compared to just getting regular care.
Quick facts
| Phase | Not applicable |
|---|---|
| Study type | Interventional |
| Enrollment | 150 (estimated) |
| Ages | 55 Years and up |
| Sex | All |
| Sponsor | VA Office of Research and Development Federal |
| Locations | 2 sites (Palo Alto, California and 1 other locations) |
| Trial ID | NCT04763330 on ClinicalTrials.gov |
What this trial studies
This clinical trial aims to reduce suicidal ideation among older veterans by comparing the effectiveness of Problem Solving Therapy (PST) combined with enhanced usual care against enhanced usual care alone. The study will involve 150 veterans aged 55 and older who are experiencing suicidal thoughts and have a diagnosis of depressive disorder, anxiety disorder, or PTSD. Participants will receive treatment through six sessions conducted entirely by phone, with assessments of suicidal ideation and reasons for living occurring at multiple timepoints. The trial seeks to understand how factors like functional disability and executive dysfunction influence treatment outcomes.
Who should consider this trial
Good fit: Ideal candidates for this study are veterans aged 55 and older who are experiencing suicidal ideation and have a diagnosis of depression, anxiety, or PTSD.
Not a fit: Patients who are at imminent risk of suicide or have a diagnosis of dementia will not benefit from this study.
Why it matters
Potential benefit: If successful, this intervention could significantly reduce suicide risk and improve mental health outcomes for older veterans.
How similar studies have performed: Previous studies have shown promise in using Problem Solving Therapy for reducing suicide risk, indicating that this approach may be effective.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * \>= 55 years old * SI (past month) on the C-SSRS * No SI or imminent risk (will be excluded) * Eligibility now includes non-specific active suicidal thoughts to active SI with some planning (on C-SSRS item 3: "Have you been thinking about how you might do this") and/or some intent to act (on C-SSRS item 4: "Have you had these thoughts and had some intention of acting on them?") provided that those endorsing item 4 have an established relationship with a psychiatrist aware of this intent level (who is not also performing psychotherapy) * Those endorsing C-SSRS item 5: "Do you intend to carry out this plan?" would be considered at imminent risk and excluded * Presence of DSM-5 depressive disorder or anxiety disorder, specified or unspecified, or PTSD or subthreshold PTSD. * No diagnosis of dementia; evidence that cognitive impairment is not indicative of possible dementia based on a negative cognitive telephone screen (\<10 errors on the Blessed cognitive screen) * No diagnosis on MINI or medical record for psychotic symptoms or disorders, bipolar disorder, or severe OCD (mild or moderate OCD will be eligible) * No history of head injury past 12 months * No severe or unstable chronic medical illness or other severe or unstable respiratory, cardiovascular, neurologic, hepatic, hematopoietic, gastrointestinal or metabolic dysfunction * AUDIT Total score \<15 for men or \<13 for women (no current alcohol use disorder) * No substance use disorder of any type for illicit substances, no moderate or severe substance use disorder for cannabis/marijuana - on the MINI. * No prominent homicidal ideation * English language proficiency to engage in treatment * Sensory abilities sufficiently intact to engage in assessment and treatment * Not currently enrolled in individual psychotherapy for a mental health issue. Participants who are receiving mental health care are eligible if their current care includes treatment from a psychiatrist, supportive therapy, peer counseling or support, or participating in psychoeducational groups. * No current prescription for anti-psychotics if prescribed for a psychotic disorder * Anti-psychotics for depression without psychosis are eligible * Psychotropic medications (e.g., SSRIs) are also eligible Exclusion Criteria: * \< 55 years old * No SI (past month) or imminent risk on the C-SSRS will be excluded. Those endorsing C-SSRS item 5: "Do you intend to carry out this plan?" would be considered at imminent risk and excluded * No DSM-5 depressive disorder or anxiety disorder, or PTSD or subthreshold PTSD * Diagnosis of dementia; evidence that cognitive impairment is indicative of possible dementia based on a positive cognitive telephone screen (\>=10 errors on the Blessed cognitive screen) * Diagnosis on MINI or medical record for psychotic symptoms or disorders, bipolar disorder, or severe OCD (mild or moderate OCD will be eligible) * History of head injury past 12 months * Severe or unstable chronic medical illness or other severe or unstable respiratory, cardiovascular, neurologic, hepatic, hematopoietic, gastrointestinal or metabolic dysfunction * AUDIT Total score \>14 for men or \>12 for women (no current alcohol use disorder) * Substance use disorder of any type for illicit substances, moderate or severe substance use disorder for cannabis/marijuana - on the MINI. * Prominent homicidal ideation * Lacking English language proficiency to engage in treatment * Sensory abilities not sufficiently intact to engage in assessment and treatment * Currently enrolled in individual psychotherapy for a mental health issue. Participants who are receiving mental health care are eligible if their current care includes treatment from a psychiatrist, supportive therapy, peer counseling or support, or participating in psychoeducational groups. * Current prescription for anti-psychotics if prescribed for a psychotic disorder, and not prescribed for depression without psychosis
Where this trial is running
Palo Alto, California and 1 other locations
- VA Palo Alto Health Care System, Palo Alto, CA — Palo Alto, California, United States (Recruiting)
- Syracuse VA Medical Center, Syracuse, NY — Syracuse, New York, United States (Recruiting)
Study contacts
- Principal investigator: Sherry A Beaudreau, PhD — VA Palo Alto Health Care System, Palo Alto, CA
- Study coordinator: Sherry A Beaudreau, PhD
- Email: Sherry.Beaudreau@va.gov
- Phone: (650) 493-5000
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.