1 National Center for Veterans Studies, Salt Lake City, Utah2 Department of Psychology, The University of Utah, Salt Lake City, Utah4 Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas5 South Texas Veterans Health Care System, San Antonio, Texas6 Department of Psychology, University of Texas at San Antonio, San Antonio, Texas7 Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, Texas8 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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ObjectiveTo determine whether group cognitive processing therapy-cognitive only version (CPT-C) is associated with iatrogenic suicide risk in a sample of active duty US Army personnel diagnosed with posttraumatic stress disorder (PTSD). Possible iatrogenic effects considered include the incidence and severity of suicide ideation, worsening of preexisting suicide ideation, incidence of new-onset suicide ideation, and incidence of suicide attempts among soldiers receiving group CPT-C. Comparison with group present-centered therapy (PCT) was made to contextualize findings.MethodOne hundred eight soldiers (100 men, eight women) diagnosed with PTSD were randomized to receive either group CPT-C or group PCT. PTSD diagnosis was confirmed via structured clinician interview. Suicide ideation, depression severity, and PTSD severity were assessed at pretreatment, weekly during treatment, and 2 weeks, 6 months, and 12 months posttreatment.ResultsRates of suicide ideation significantly decreased across both treatments. Among soldiers with pretreatment suicide ideation, severity of suicide ideation significantly decreased across both treatments and was maintained for up to 12 months posttreatment. Exacerbation of preexisting suicide ideation was uncommon in both treatments. New-onset suicide ideation was rare and similar across both treatments (<16%). There were no suicide attempts during treatment or follow-up in either group. Change in depression symptoms predicted change in suicide risk.ConclusionsSuicide-related outcomes were similar across both treatments and primarily associated with comorbid depression. Suicide-related outcomes in group CPT-C were rare and comparable to patterns observed in an active, nontrauma-focused therapy, even among soldiers who entered treatment with suicide ideation.Clinical Trials.gov IdentifierNCT01286415,https://clinicaltrials.gov/ct2/show/NCT01286415.