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J Psychiatr Res. 2016 Sep;80:59-63. doi: 10.1016/j.jpsychires.2016.05.011. Epub 2016 May 27.

Reducing suicidal ideation through evidence-based treatment for posttraumatic stress disorder.

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Department of Psychology, University of North Carolina Asheville, One University Heights, Asheville, NC, 28803, United States. Electronic address:
Psychology Department, University of Georgia, 125 Baldwin St., Athens, GA, 30602, United States.
VA Ann Arbor Health Care System, 2215 Fuller Rd, Ann Arbor, MI, 48105, United States; Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, 48109, United States.
Evidence-Based Practice Institute, 3303 S Irving St, Seattle, WA, 98144, United States.
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Dr. NE #200, Atlanta, GA, 30329, United States.
Minneapolis VA Health Care System, 1 Veterans Dr., Minneapolis, MN, 55417, United States; Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, 55454, United States.
Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32304, United States.
Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC, 29401, United States; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC, 29425, United States.



Suicide is a major public health concern in military and civilian contexts. Veteran populations are at increased risk for suicide, especially veterans with mental health disorders such as Posttraumatic Stress Disorder (PTSD). Suicidal ideation (SI) is a primary risk factor for suicide.


We investigated changes in SI in a multi-site sample of treatment seeking veterans from three separate Veterans Health Administration (VA) medical centers (n = 289) who received Prolonged Exposure (PE) therapy, an evidence-based treatment (EBT) for PTSD. SI and PTSD symptoms were assessed, using self-report instruments, throughout routine clinical care.


Both PTSD and SI symptoms reduced over the course of treatment (d-type effect sizes of 1.47 and 0.27, respectively). While SI was associated with PTSD symptoms at all time points, appropriately specified, time lagged models indicated that changes in PTSD symptoms were predictive of future declines in SI, while the converse was not true.


Results indicate that treating PTSD symptoms with an EBT for PTSD can be an effective way to reduce SI, at least partially, and for some patients. These data are significant in light of the resources and programming devoted to addressing SI in the VA relative to available empirical evidence regarding the effectiveness of developed strategies. The findings demonstrate the importance of facilitating EBT referrals for specific disorders as a component of broad-based suicide outreach and preventions strategies.


Effectiveness research; Evidence-based treatments (EBTs); Posttraumatic stress disorder (PTSD); Suicidal ideation; Suicide; Suicide prevention

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