Category: Treatment - CBT

Symposium

Clinically Significant Change in a Pilot Trial of Postadmission Cognitive Therapy: An Inpatient Cognitive Behavioral Protocol for Military Suicide Prevention

Saturday, November 18
3:30 PM - 5:00 PM
Location: Aqua Salon E & F, Level 3, Aqua Level

Keywords: Suicide | Prevention | Military
Presentation Type: Symposium

Background: Few empirically validated suicide-prevention treatments for the psychiatric inpatient milieu exist. Therefore, there is an urgent need for efficacious inpatient interventions targeting suicide risk (Ghahramanlou-Holloway et al., 2015). Purpose: Findings from a pilot randomized clinical trial (RCT) of Post Admission Cognitive Therapy (PACT; Ghahramanlou-Holloway et al., 2012) will be presented. PACT is a brief, targeted cognitive behavioral intervention, delivered to military personnel during inpatient psychiatric stay. Methodology: Service members (N = 24) hospitalized due to a recent suicide attempt were randomized into either PACT + Enhanced Usual Care (EUC) or EUC. Follow-up assessments occurred at 1-, 2-, and 3-months post psychiatric discharge. Individuals who demonstrated both statistically reliable changeand clinically relevant improvement were classified as having made “clinically significant change”, as described by Jacobson and Truax (1991). Reliable Change Index score greater than ±1.96 indicated statistically reliable change. Outcomes were assessed via the Beck Depression Inventory-II (BDI-II; Beck et al., 1996), Beck Hopelessness Scale (BHS; Beck & Steer, 1988), the Scale for Suicide Ideation (SSI; Beck et al., 1979), and the Alcohol Use Disorders Identification Test (AUDIT; Barbor et al., 2001). Results: A greater proportion of PACT versus EUC participants showed clinically significant change on the SSI-Worst (45% vs. 30%) and the BDI (18% vs. 10%), but not on the BHS (18% vs. 30%). PACT and EUC participants were equally likely to demonstrate clinically significant change on the AUDIT (25% of each group). However, when analyses were limited to participants who scored above the pre-determined cutoff scores at baseline for each measure, those receiving PACT versus EUC were more likely to meet criteria for clinically significant change on the SSI-Worst (45% vs. 33%), BDI (40% vs. 25%), and BHS (67% vs. 50%). Conclusions: To address the limitations of this pilot trial, a well-powered, multi-site RCT is currently underway to determine the efficacy of the PACT intervention in reducing suicide risk among psychiatric military inpatients.

Marjan Ghahramanlou-Holloway

Associate Professor
Uniformed Services University of the Health Sciences

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