Improving Suicide Risk Screening to Identify the Highest Risk Patients: Results From the PRImary Care Screening Methods (PRISM) Study.

PURPOSE: Over 95% of patients who screen positive on the Patient Health Questionnaire-9 (PHQ-9) suicide risk item do not attempt or die by suicide, which could lead to unnecessary treatment and/or misallocation of limited resources. The present study seeks to determine if suicide risk screening can be meaningfully improved to identify the highest-risk patients. METHODS: Patients eligible to receive medical treatment from the US Department of Defense medical system were recruited from 6 military primary care clinics located at 5 military installations around the United States. Patients completed self-report measures including the PHQ-9 and 16 items from the Suicide Cognitions Scale (SCS) during routine primary care clinic visits. Postbaseline suicidal behaviors (suicide attempts, interrupted attempts, and aborted attempts) were assessed by evaluators who were blind to screening results using the Self-Injurious Thoughts and Behaviors Interview. RESULTS: Among 2,744 patients, 13 (0.5%) engaged in suicidal behavior in the 30 days after screening and 28 (1.0%) displayed suicidal behavior in the 90 days after screening. Multiple SCS items differentiated patients with suicidal behavior less than 30 days after screening positive for suicide risk. Augmenting the PHQ-9 suicide risk item with SCS items improved the identification of patients who were most likely to have suicidal behavior within a month of screening positive without sacrificing sensitivity. CONCLUSION: Among primary care patients who screen positive for suicide risk on the PHQ-9, SCS items improved screening efficiency by identifying those patients who are most likely to engage in suicidal behavior within the next 30 days.

Acceptability, Feasibility, and Preliminary Effectiveness of Group Cognitive Processing Therapy with Female Adolescent Survivors of Commercial Sexual Exploitation in Cambodia.

Research supports the efficacy of cognitive processing therapy (CPT) for reducing Posttraumatic Stress Disorder (PTSD) and comorbid conditions among survivors of sexual assault and other traumas. To date, there are no known studies using CPT with adolescents exposed to commercial sexual exploitation (CSE). The pilot study implemented a modified version of group CPT to determine the preliminary acceptability and feasibility of this intervention with adolescents who experienced CSE. Thirteen participants living in a residential treatment facility in Cambodia received 10 sessions of modified group CPT. Participants were adolescents ranging in age from 14 to 19. Measures of PTSD, depression symptom severity, and suicidal and non-suicidal ideation and behaviors were obtained at baseline, during the intervention, and 1-week and 3 months posttreatment. Group attendance rates and client satisfaction measures of the intervention were obtained. Client satisfaction with the group intervention was high (mean = 27, SD 2.61) and group attendance was good. There was a significant decline in PTSD symptom severity F(7,24) = 2.60, p = .037 and a significant decline in depression symptom severity over time F(7,12) = 9.67, p < .001. There were no occurrences of suicidal or non-suicidal behavior during the study or at follow-up with one participant reporting suicidal ideation after treatment began. The modified CPT intervention appeared to be feasible and received a high acceptability rating.

Correction to: Acceptability, Feasibility, and Preliminary Effectiveness of Group Cognitive Processing Therapy with Female Adolescent Survivors of Commercial Sexual Exploitation in Cambodia.

[This corrects the article DOI: 10.1007/s40653-021-00405-6.].

Military sexual trauma and suicidal behavior among National Guard personnel.

BACKGROUND: Preliminary evidence suggests military sexual trauma (MST) may be associated with increased risk for suicidal behaviors among active duty military personnel and veterans. Among National Guard personnel, a high-risk subgroup, MST and suicide risk have not received much empirical attention. PURPOSE: To examine the association of MST with suicide ideation and suicide attempts among National Guard personnel. PROCEDURES: N = 997 National Guard personnel from Idaho and Utah participated in an anonymous online survey. Weighted analyses were conducted to minimize sampling bias. MAIN FINDINGS: 9% of participants had a history of MST (6% of men, 28% of women). Among participants reporting MST, 68% reported a service member perpetrator and 44% reported a civilian perpetrator (12% reported both). A history of MST was associated with significantly increased risk for lifetime suicide attempt. MST remained a significant predictor of lifetime suicide attempt even when restricting the sample to the subgroup with a history of suicidal thoughts (n = 257, 27% of full sample). When adjusting for premilitary sexual victimization, MST was no longer significantly associated with lifetime suicide attempts, but premilitary sexual victimization was. CONCLUSIONS: The rate of MST among National Guard personnel is comparable to rates among active duty military personnel, although the perpetrators of MST are less likely to be service members. MST is a risk factor for suicide attempts, but premilitary sexual victimization is a relatively stronger risk factor.