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Journal Article Ahead of print 3 citations

PubMed: 41060644 DOI: 10.1001/jamapsychiatry.2025.2850

Brief Cognitive Behavioral Therapy for Suicidal Military Personnel and Veterans: The Military Suicide Prevention Intervention Research (MSPIRE) Randomized Clinical Trial.

JAMA Psychiatry

Authors: Craig J Bryan, Lauren R Khazem, Justin C Baker, Lily A Brown, Daniel J Taylor, Kristi E Pruiksma, Ron Acierno, Jayme G Larick, Brian R W Baucom, Eric L Garland, M David Rudd

Affiliations

  • The Ohio State University, Columbus.
  • University of Pennsylvania, Philadelphia.
  • University of Arizona, Tucson.
  • University of Texas Health Science Center at San Antonio, San Antonio.
  • University of Texas Health Science Center at Houston, Houston.
  • Ralph H. Johnson VA Healthcare System, Charleston, South Carolina.
  • Naval Medical Center Camp Lejeune, Jacksonville, North Carolina.
  • University of Utah, Salt Lake City.
  • University of California San Diego, La Jolla.
  • University of Memphis, Memphis, Tennessee.

Abstract

IMPORTANCE

US military personnel and veterans have higher rates of suicide than the general population. Previous trials support the efficacy of brief cognitive behavioral therapy (BCBT) for reducing suicide attempts among military personnel compared with treatment as usual, and replication of these findings is needed.

OBJECTIVE

To test the efficacy of BCBT for reducing suicide attempts and suicidal ideation among high-risk military personnel and veterans.

DESIGN, SETTING, AND PARTICIPANTS

This was a 2-arm, parallel randomized clinical trial comparing BCBT with present-centered therapy (PCT), conducted from 2020 to 2025. The setting was 3 US-based outpatient psychiatric clinics and included US military personnel and veterans reporting suicidal ideation during the past week and/or suicidal behavior during the past month who were either self-referred or referred by their mental health clinicians.

INTERVENTIONS

Participants were randomly assigned to either BCBT, a psychotherapy that teaches emotion regulation skills, or PCT, a problem-solving psychotherapy, using a computerized algorithm with stratification for sex and number of prior suicide attempts.

MAIN OUTCOMES AND MEASURES

The primary outcome was suicide attempt, assessed with the Self-Injurious Thoughts and Behaviors Interview-Revised.

RESULTS

Of 154 individuals assessed for eligibility, 108 (mean [SD] age, 32.8 [12.8] years; 79 male [73.1%]) were enrolled. Fewer patients receiving BCBT (n = 2, estimated proportion = 5.6%) than PCT (n = 8, estimated proportion = 27.9%) attempted suicide during follow-up. Mean time to first suicide attempt was 638.6 (90% CI, 557.8-719.3) days in the PCT group vs 755.9 (90% CI, 715.1-796.8) days in the BCBT group (log-rank χ21 = 3.6; P = .03). BCBT significantly reduced the risk of any suicide attempt (hazard ratio [HR], 0.25; 90% CI, 0.07-0.90; P = .04) as well as the rate of follow-up suicide attempts (0.06 vs 0.18 attempts per participant-year, risk ratio, 0.24; 90% CI, 0.08-0.70; P = .02). Suicidal ideation significantly decreased in both groups (F8,264 = 7.2, P < .001) with no differences between groups (F8,266 = 0.2; P = .49).

CONCLUSIONS AND RELEVANCE

This randomized clinical trial found that BCBT reduced suicide attempts among US military personnel and veterans reporting recent suicidal ideation and/or suicidal behaviors compared with an active comparator. These results replicate earlier findings.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03769259.

MeSH

Military Personnel, Mental Disorders, Psychotherapy, Veterans, Research, Therapeutics, Suicidal Ideation, Cognitive Behavioral Therapy, Suicide, Attempted, Suicide, Suicide Prevention