The military veteran population has an increased risk for suicide when compared to non-vets. Almost 18 veterans are lost to suicide each day. The Veterans Health Administration has prioritized investigating ways to lower suicide risk, and mindfulness interventions might be protective against mental health disruptions that are linked with suicide.
Interian et al. [Journal of Clinical Psychiatry] tested the effects of Mindfulness-Based Cognitive Therapy for Suicide (MBCT-S) on suicide-related events when added to the Veterans Health Administration enhanced standard treatment in a cohort of veterans at high risk for suicide.
The researchers randomly assigned 140 veterans at high risk for suicide (average age = 47; 88% male; 45% White, 28% Black, 21% Latino, 6% other) to enhanced treatment-as-usual alone, or enhanced treatment-as-usual with adjunctive MBCT-S. Eighty-four percent of the participants had histories of a prior suicide attempt, and 79% had made multiple attempts.
Most of the participants began the study as inpatients when hospitalized for suicidal behavior or ideation and then continued the study as outpatients while under psychiatric monitoring.
MBCT-S consisted of two individual treatment sessions during inpatient care, 8 weekly group sessions after transition to outpatient care, and optional monthly after-care booster sessions. The curriculum modeled MBCT for recurrent depression with added emphasis on accepting and disengaging from suicide related thoughts, feelings, and behaviors.
Enhanced treatment-as-usual included suicide safety planning while still an inpatient and 6 post-hospitalization mental health visits to monitor suicidal status and bolster safety planning. These specific enhancements are above and beyond the usual care offered for low-suicide risk psychiatric disorders.
Participants received routine standard health services in the veterans system including outpatient psychotherapy, medication, and residential support.
Participants were assessed on measures of depression, hopelessness, suicidal ideation and distress tolerance at baseline, mid-treatment, post-treatment, and 6-and 12-month follow-up. Medical records were assessed for suicide-related events (attempts, preparations for suicide, and hospitalizations for suicidal thinking).
Over the course of the 12 months, 148 suicide-related events occurred with 19% of the cohort attempting suicide. The results showed a significantly fewer number of suicide-related events in the MBCT-S group (56 vs. 92) with a significantly smaller proportion of the MBCT-S group making suicide attempts (13% vs. 26%) or being hospitalized for suicidal thinking (30% vs 46%).
Participants improved significantly, and to an equivalent degree, on measures of depression, hopelessness, suicidal ideation, and distress tolerance.
The study shows MBCT-S added to enhanced standard psychiatric care can reduce the proportion of high-risk veterans who make suicide attempts or require hospitalization for suicidal thoughts when compared to enhanced standard psychiatric care alone. This was an impressive finding given the intensity of services received by the standard care group.
Interian, A., Chesin, M. S., Stanley, B., Latorre, M., Hill, L. M. S., Miller, R. B., King, A. R., Boschulte, D. R., Rodriguez, K. M., & Kline, A. (2021). Mindfulness-Based Cognitive Therapy for Preventing Suicide in Military Veterans: A Randomized Clinical Trial. The Journal of Clinical Psychiatry.
Link to study