Pilot Trial of Inpatient Cognitive Therapy for the Prevention of Suicide in Military Personnel

Participation in military operations, especially in times of war, places personnel and their
family members at increased risk for mental health problems. In 2003, among the 1.4 million
active duty United States service members, mental disorders remained the leading cause of
hospitalization for men and the second leading cause of hospitalization for women.
Posttraumatic stress disorder (PTSD) and suicide behavior among military personnel are the
leading causes of psychiatric hospitalization. Both are considered significant public health
problems. Existing literature provides strong support for the relationship between PTSD and
suicide ideation, attempts, and deaths. PTSD, in fact, shows the strongest association with
suicide behavior of any of the anxiety disorders and has equal or greater odds ratio than
mood disorders for resulting in impulsive suicide attempts. However, to date, no
evidence-based interventions have been developed for individuals with PTSD who attempt
suicide. Therefore, the investigators aim to develop, implement, and evaluate an inpatient
based cognitive behavioral care plan for service members and beneficiaries, with symptoms of
either Acute Stress Disorder (ASD) or PTSD, who are admitted for hospitalization following a
recent suicide attempt.

The investigators will randomize 50 traumatized patients hospitalized at the Walter Reed Army
Medical Center for a recent suicide attempt to one of two conditions: (1) Post-Admission
Cognitive Therapy + Enhanced Usual Care (PACT+EUC) or (2) Enhanced Usual Care (EUC).
Individuals who are over the age of 18, able to communicate in English and willing to provide
informed consent will be recruited. The PACT+EUC condition will consist of six 1-hr
individual cognitive therapy sessions administered over 3 days over the course of the
patient's hospital stay. The EUC condition will consist of the usual care patients receive at
an inpatient facility during their hospitalization in addition to assessment services
provided by independent evaluators who work directly with our research team. The primary
outcome variable is the number of subsequent suicide attempts. The investigators expect that
patients in the control condition will reattempt suicide at an earlier date and at a higher
frequency as compared to patients enrolled in the intervention condition. Secondary outcome
measures include the severity of depression, hopelessness, suicide ideation, and post
traumatic symptoms. Patients in both conditions will be assessed on the dependent measures at
baseline and at 1-, 2-, and 3- month follow-up intervals. Data analyses will provide
estimates of the level of improvement demonstrated by the intervention condition, PACT
relative to the control condition, EUC over time.

The development and subsequent dissemination of innovative inpatient focused interventions
for traumatized individuals with suicide attempt behavior will significantly contribute to
our national and military suicide prevention objectives. The research aims to effectively
utilize a unique window of opportunity during the hospitalization period following a recent
suicide attempt to deliver a brief and targeted intervention to military personnel and family
members diagnosed with a trauma-related condition. If our designed intervention demonstrates
to be clinically feasible, acceptable, and associated with preliminary evidence of
improvement in symptoms relative to the control condition, a larger randomized controlled
trial will be proposed to definitively determine the efficacy of the intervention. Without
adequate treatment, PTSD and suicide behavior may result in costly utilization of social
services, human suffering, and eventual death. The Department of Veterans Affairs reports
that veterans as compared to the general US population are at greater risk for suicide by
almost 23%. The study targets at-risk individuals immediately following psychiatric
hospitalization to minimize the likelihood of future complications as seen previously with
Vietnam veterans. The projected time to achieve a consumer-related outcome would be 3-5
years.

Inclusion Criteria

1. Suicide Attempt (Recent or Lifetime) Psychiatric Admission

2. History of Trauma

3. Baseline Completed within 48 Hours of Admission

4. Over the Age of 18

5. Provides Informed Consent

Exclusion Criteria

1. Self-Inflicted Harm with No Intent or Desire to Die

2. Medical Incapacity to Participate

3. Current State of Active Psychosis

4. Expected Discharge within 72 Hours of Admission