Post Admission Cognitive Therapy (PACT) for the Inpatient Treatment of Military Personnel With Suicidal Behaviors

Background: Suicide remains a serious national public health problem and has become a leading
cause of death in the United States military. To date, there is no evidence-based civilian or
military inpatient interventions aimed at the reduction of suicide behavior. Our proposal
addresses this important gap and aims to evaluate an innovative suicide intervention, Post
Admission Cognitive Therapy (PACT). Left untreated, severe suicide ideation and/or suicide
attempts that require psychiatric hospitalization may place an individual at a lifetime risk
for increased psychopathology, subsequent suicide behavior, and death.

Objective: The broad objective is to implement and empirically evaluate the efficacy of a
cognitive behavioral intervention program, titled Post Admission Cognitive Therapy (PACT),
for military service members and beneficiaries [with Veterans expected to be added] admitted
for inpatient care due to severe suicide ideation (with lifetime history of suicide attempt)
and/or a recent suicide attempt.

Specific Aims: To evaluate the efficacy of PACT plus Enhanced Usual Care (EUC) versus EUC for
the prevention of suicide in psychiatrically hospitalized military personnel and
beneficiaries [with Veterans expected to be added] at follow-up (1, 3, 6, and 12-month) on
(1) incidence of repeat suicide attempt(s) and number of days until a repeat suicide attempt
(primary outcomes), and (2) psychiatric symptoms (depression, trauma, sleep, suicide
ideation), repeat number of psychiatric hospitalization(s), hope for one's future, and
acceptability of treatment (as measured by time to linkage to specialty care, attitudes
toward seeking help for mental health issues, and subsequent mental health service
utilization) (secondary outcomes). The investigators expect that adults in the PACT+EUC
(experimental) condition compared to those in the EUC (control) condition will show favorable
outcomes on both primary and secondary measures.

Study Design: The research design is a multi-site, single-blind, randomized controlled trial
(RCT). A total of 218 individuals who are over the age of 18, able to communicate in English
and willing to provide informed consent will be recruited from the inpatient psychiatric
units at the Walter Reed National Military Medical Center and the Fort Belvoir Community
Hospital [Washington DC VA expected to be added as third site]. Participants will be
randomized into one of two conditions: (1) [Post Admission Cognitive Therapy (PACT) +
Enhanced Usual Care (EUC)] or (2) Enhanced Usual Care (EUC). Individuals randomized into
PACT+EUC will participate in the study assessments, receive six 60-90 minute individual
face-to-face PACT psychotherapy sessions provided during their inpatient stay, up to a
maximum of four 30-minute phone PACT booster sessions during the 3 months post hospital
discharge, and case management services for 12 months. Individuals randomized into the
control condition (EUC) will not receive the study intervention; they will receive the usual
care provided in the inpatient setting, participate in study assessments, and receive case
management services for 12 months. Patients in both conditions will be assessed on the
dependent measures at baseline and at 1-, 3-, 6-, and 12-month follow-up intervals.

Relevance: Delivering a brief and possibly potent psychotherapeutic intervention during a
psychiatric inpatient hospitalization followed by an aftercare component aims to directly
target individuals at high risk for future suicide behavior, specifically psychiatrically
hospitalized adults. The development and empirical validation of an inpatient cognitive
behavioral treatment is a significant endeavor in our national as well as Department of
Defense (DoD) suicide prevention efforts. If Post Admission Cognitive Therapy is found to be
efficacious, the intervention can be subsequently disseminated to inpatient settings as the
standard of care for military personnel and beneficiaries as well as Veterans admitted for
suicide-related events.

Inclusion Criteria:

- Reason for Admission: Suicide-Related Event

- Baseline Completed within Preferably 48-72 Hours of Admission

- Over the Age of 18

- Provides Informed Consent

Exclusion Criteria:

- Medical Incapacity to Participate

- Serious Cognitive Impairment

- Expected Discharge within 72 Hours of Admission