Reducing Suicide Risk in Older Veterans Using Problem Solving Therapy

Stopped early · Not applicable

Conditions studied: Suicidal Ideation, Depressive Disorder, Anxiety Disorders, Post Traumatic Stress Disorder

In brief

Suicide is a national crisis, especially among older Veterans for whom evidence-based suicide prevention efforts are lacking. This proposal responds to the national priority to develop and improve interventions for suicide prevention, with a focus on at-risk older Veterans. The randomized control trial will compare VA usual care, which is suicide safety planning, with brief Problem Solving Therapy and suicide safety planning. This study uses Problem Solving Therapy because it has support from our pilot data and from secondary data analysis from other studies for reducing late life suicide risk. This treatment also has support for alleviating two key risk factors for late life suicide risk, functional disability and executive dysfunction, and thus this study will examine how older Veterans with varying levels of functional disability and executive functioning respond to treatment to inform future targeted implementation. In accordance with national priorities, existing infrastructure in Problem Solving Training could be expanded to support more rapid VA-wide implementation.

Key facts

Study ID: NCT04763330
Run by: VA Office of Research and Development
People needed: 117
Starts: 2022-01-24
Expected to finish: 2025-11-05
Last updated by the study team: 2026-01-16

Who can join

Age: 55 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

>= 55 years old
SI (past month) on the C-SSRS
No SI or imminent risk (will be excluded)
Eligibility now includes non-specific active suicidal thoughts to active SI with some planning (on C-SSRS item 3: "Have you been thinking about how you might do this") and/or some intent to act (on C-SSRS item 4: "Have you had these thoughts and had some intention of acting on them?") provided that those endorsing item 4 have an established relationship with a psychiatrist aware of this intent level (who is not also performing psychotherapy)
Those endorsing C-SSRS item 5: "Do you intend to carry out this plan?" would be considered at imminent risk and excluded
Presence of DSM-5 depressive disorder or anxiety disorder, specified or unspecified, or PTSD or subthreshold PTSD.
No diagnosis of dementia; evidence that cognitive impairment is not indicative of possible dementia based on a negative cognitive telephone screen (<10 errors on the Blessed cognitive screen)
No diagnosis on MINI or medical record for psychotic symptoms or disorders, bipolar disorder, or severe OCD (mild or moderate OCD will be eligible)
No history of head injury past 12 months
No severe or unstable chronic medical illness or other severe or unstable respiratory, cardiovascular, neurologic, hepatic, hematopoietic, gastrointestinal or metabolic dysfunction
AUDIT Total score <15 for men or <13 for women (no current alcohol use disorder)
No substance use disorder of any type for illicit substances, no moderate or severe substance use disorder for cannabis/marijuana - on the MINI.
No prominent homicidal ideation
English language proficiency to engage in treatment
Sensory abilities sufficiently intact to engage in assessment and treatment
Not currently enrolled in individual psychotherapy for a mental health issue. Participants who are receiving mental health care are eligible if their current care includes treatment from a psychiatrist, supportive therapy, peer counseling or support, or participating in psychoeducational groups.
No current prescription for anti-psychotics if prescribed for a psychotic disorder
Anti-psychotics for depression without psychosis are eligible
Psychotropic medications (e.g., SSRIs) are also eligible

You may not qualify if…

< 55 years old
No SI (past month) or imminent risk on the C-SSRS will be excluded. Those endorsing C-SSRS item 5: "Do you intend to carry out this plan?" would be considered at imminent risk and excluded
No DSM-5 depressive disorder or anxiety disorder, or PTSD or subthreshold PTSD
Diagnosis of dementia; evidence that cognitive impairment is indicative of possible dementia based on a positive cognitive telephone screen (>=10 errors on the Blessed cognitive screen)
Diagnosis on MINI or medical record for psychotic symptoms or disorders, bipolar disorder, or severe OCD (mild or moderate OCD will be eligible)
History of head injury past 12 months
Severe or unstable chronic medical illness or other severe or unstable respiratory, cardiovascular, neurologic, hepatic, hematopoietic, gastrointestinal or metabolic dysfunction
AUDIT Total score >14 for men or >12 for women (no current alcohol use disorder)
Substance use disorder of any type for illicit substances, moderate or severe substance use disorder for cannabis/marijuana - on the MINI.
Prominent homicidal ideation
Lacking English language proficiency to engage in treatment
Sensory abilities not sufficiently intact to engage in assessment and treatment
Currently enrolled in individual psychotherapy for a mental health issue. Participants who are receiving mental health care are eligible if their current care includes treatment from a psychiatrist, supportive therapy, peer counseling or support, or participating in psychoeducational groups.
Current prescription for anti-psychotics if prescribed for a psychotic disorder, and not prescribed for depression without psychosis

Where it is running

VA Palo Alto Health Care System, Palo Alto, CA — Palo Alto, California, United States
Syracuse VA Medical Center, Syracuse, NY — Syracuse, New York, United States

Full record on ClinicalTrials.gov

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