Differential Effects of Brief CBT Versus Treatment as Usual on Posttreatment Suicide Attempts Among Groups of Suicidal Patients.

Objective: The purpose of this study was to examine variability in outcomes (suicide attempt rates) across subgroups of patients who were randomly enrolled in brief cognitive-behavioral therapy (CBT) and treatment as usual. Methods: A secondary analysis was conducted of data collected during a randomized clinical trial of brief CBT for suicide prevention in a sample of 176 U.S. military personnel who reported active suicide ideation in the past week or a suicide attempt in the past month. Latent-class analysis was used to identify empirically distinct and clinically meaningful patient subgroups. Rates of suicide attempts during a two-year follow-up period were compared across classes and treatment groups. Results: Three latent classes corresponding to low (N=55), moderate (N=40), and high (N=57) suicide risk were identified. The classes significantly differed with respect to psychiatric symptom severity but not demographic or historical variables. Rates of suicide attempts during the two-year follow-up significantly varied across classes in treatment as usual but did not vary across classes in brief CBT (21% versus 10%, respectively, in the low-severity class, 8% versus 13% in the moderate-severity class, and 41% versus 10% in the high-severity class). Differences between treatment conditions in suicide attempt rates were statistically significant for the high-severity class. Conclusions: Treatment as usual was associated with variable rates of suicidal behavior, depending on suicide risk severity. Brief CBT contributed to consistently low rates of suicidal behavior regardless of patient severity.