title: A Randomized Trial of Dialectical Behavior Therapy in High-Risk Suicidal Veterans.
abstract: OBJECTIVE
  Despite advances in suicide prevention implemented throughout the US Department of Veterans Affairs (VA) including the hiring of Suicide Prevention Coordinators (SPCs) at every VA hospital, enhanced monitoring, and the availability of 24-hour crisis hotline services, suicide by veterans remains a critical problem affecting 20 veterans daily. Few empirically based treatment strategies for suicide prevention for postdeployment military personnel exist. This study aimed to test whether dialectical behavior therapy (DBT), one of the few psychosocial treatments with proven efficacy in diminishing suicidal behavior in individuals with personality disorder, can be applied to veterans irrespective of personality diagnosis.
  
  
  METHODS
  From January 2010 to December 2014, 91 nonpsychotic veterans at high risk for suicide (61 men, 30 women) were randomly assigned to a 6-month treatment trial at a veterans' medical center comparing standard DBT to treatment as usual (TAU) and followed for 6 months after trial completion. Primary outcome was suicide attempts, measured with the Columbia-Suicide Severity Rating Scale, and secondary outcomes were suicide ideation, depression, hopelessness, and anxiety. There were no exclusions pertaining to substance abuse, homelessness, or medical comorbidity.
  
  
  RESULTS
  Both DBT and TAU resulted in improvements in suicidal ideation, depression, and anxiety during the course of the 6-month treatment trial that did not differ between treatment arms. Survival analyses for suicide attempts and hospitalizations did not differ between treatment arms. However, DBT subjects utilized significantly more individual mental health services than TAU subjects (28.5 ± 19.6 vs 14.7 ± 10.9, F₁,₇₇ = 11.60, P = .001).
  
  
  CONCLUSIONS
  This study is the first to examine 6-month DBT in a mostly male, veteran population. Increased mental health treatment service delivery, which included enhanced monitoring, outreach, and availability of a designated SPC, did not yield statistically significant differences in outcome for veterans at risk for suicide in TAU as compared to the DBT treatment arm. However, both treatments had difficulty with initial engagement post-hospitalization. Future studies examining possible sex differences and strategies to boost retention in difficult-to-engage, homeless, and substance-abusing populations are indicated.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT02462694.
authors: MIRECC, Room 6A-44, James J. Peters VA Medical Center, Bronx, NY 10468. marianne.goodman@va.gov.|Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.|VISN 3 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, New York, USA.|Outpatient Psychiatry, James J. Peters VA Medical Center, Bronx, New York, USA.
authors: Marianne
authors: M
authors: Goodman
authors: Center for Intensive Treatment of Personality Disorders, Mount Sinai-St Luke's/Roosevelt, New York, New York, USA.
authors: David
authors: D
authors: Banthin
authors: VISN 3 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, New York, USA.
authors: Nicholas J
authors: NJ
authors: Blair
authors: VISN 3 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, New York, USA.
authors: Kathryn A
authors: KA
authors: Mascitelli
authors: VISN 3 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, New York, USA.
authors: Jaime
authors: J
authors: Wilsnack
authors: VISN 3 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, New York, USA.
authors: Jennifer
authors: J
authors: Chen
authors: VISN 3 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, New York, USA.
authors: Julie W
authors: JW
authors: Messenger
authors: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors: M Mercedes
authors: MM
authors: Perez-Rodriguez
authors: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.|Outpatient Psychiatry, James J. Peters VA Medical Center, Bronx, New York, USA.
authors: Joseph
authors: J
authors: Triebwasser
authors: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.|Outpatient Psychiatry, James J. Peters VA Medical Center, Bronx, New York, USA.
authors: Harold W
authors: HW
authors: Koenigsberg
authors: Division of Clinical Phenomenology, New York State Psychiatric Institute, New York, USA.|Columbia University, College of Physicians and Surgeons, New York, New York, USA.
authors: Raymond R
authors: RR
authors: Goetz
authors: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.|VISN 3 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, New York, USA.
authors: Erin A
authors: EA
authors: Hazlett
authors: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors: Antonia S
authors: AS
authors: New
mesh_terms: D000328:Adult; D001007:Anxiety / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods*; D003863:Depression / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D065026:Hope; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011615:Psychotherapy, Group; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000517:prevention & control*; D014728:Veterans / Q000523:psychology*