Reducing Suicide Risk in Older Veterans Using Problem Solving Therapy

Description

Suicide is a national crisis, especially among older Veterans for whom evidence-based suicide prevention efforts are lacking. This proposal responds to the national priority to develop and improve interventions for suicide prevention, with a focus on at-risk older Veterans. The randomized control trial will compare VA usual care, which is suicide safety planning, with brief Problem Solving Therapy and suicide safety planning. This study uses Problem Solving Therapy because it has support from our pilot data and from secondary data analysis from other studies for reducing late life suicide risk. This treatment also has support for alleviating two key risk factors for late life suicide risk, functional disability and executive dysfunction, and thus this study will examine how older Veterans with varying levels of functional disability and executive functioning respond to treatment to inform future targeted implementation. In accordance with national priorities, existing infrastructure in Problem Solving Training could be expanded to support more rapid VA-wide implementation.

Conditions

Suicidal Ideation, Depressive Disorder, Anxiety Disorders, Post Traumatic Stress Disorder

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Study Overview

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Study Details

Study overview

Suicide is a national crisis, especially among older Veterans for whom evidence-based suicide prevention efforts are lacking. This proposal responds to the national priority to develop and improve interventions for suicide prevention, with a focus on at-risk older Veterans. The randomized control trial will compare VA usual care, which is suicide safety planning, with brief Problem Solving Therapy and suicide safety planning. This study uses Problem Solving Therapy because it has support from our pilot data and from secondary data analysis from other studies for reducing late life suicide risk. This treatment also has support for alleviating two key risk factors for late life suicide risk, functional disability and executive dysfunction, and thus this study will examine how older Veterans with varying levels of functional disability and executive functioning respond to treatment to inform future targeted implementation. In accordance with national priorities, existing infrastructure in Problem Solving Training could be expanded to support more rapid VA-wide implementation.

Reducing Suicide Risk in Older Veterans With Mental Health Disorders Using Problem Solving Therapy

Reducing Suicide Risk in Older Veterans Using Problem Solving Therapy

Condition
Suicidal Ideation
Intervention / Treatment

-

Contacts and Locations

Palo Alto

VA Palo Alto Health Care System, Palo Alto, CA, Palo Alto, California, United States, 94304-1207

Syracuse

Syracuse VA Medical Center, Syracuse, NY, Syracuse, New York, United States, 13210

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

For general information about clinical research, read Learn About Studies.

Eligibility 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
  • * \< 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

Ages Eligible for Study

55 Years to

Sexes Eligible for Study

ALL

Accepts Healthy Volunteers

No

Collaborators and Investigators

VA Office of Research and Development,

Sherry A Beaudreau, PhD, PRINCIPAL_INVESTIGATOR, VA Palo Alto Health Care System, Palo Alto, CA

Study Record Dates

2026-03-31