BALTIMORE – Family-focused treatment might be an effective intervention for veterans at risk for suicide, based on findings from a preliminary study with 52 veterans and their families at one U.S. center.
Future work could involve modifying conventional family-focused treatment (FFT) to make it more appropriate for veterans with suicidal thoughts and behaviors, Elizabeth D. Ballard said at the annual conference of the American Association of Suicidology.
The assessment she and her associates performed included 52 veterans with suicidal thoughts and behaviors and their families who self-selected to participate in a series of FFT sessions at the Veterans Affairs Medical Center in Denver. Each veteran participated in an average of 13 sessions; the median number of sessions for each veteran was 14.
Elizabeth D. Ballard
Before the FFT intervention began, 24 of the 52 veterans (46%) had been hospitalized at least once for a suicide-related cause, and in the year preceding the start of the FFT sessions 14 (27%) had at least one suicide-related hospitalization. The hospitalization rate appeared to drop off during and after the FFT program, with six participants (12%) requiring hospitalization for a suicide-related cause during FFT, six needing hospitalization immediately after the FFT program, and three (6%) hospitalized for a suicide-related reason during the year after the program, said Ms. Ballard, a researcher in the Mental Illness Research Education and Clinical Center at the VA Medical Center in Denver.
The effect on suicide-related hospitalizations was "striking," and provides a basis for further study of FFT as an intervention for veterans at risk for suicide, Ms. Ballard said in an interview. But she emphasized that the current study had not been designed to measure the efficacy of FFT in this setting.
She and her associates looked at FFT because the treatment was originally developed for patients with bipolar disorder (Am. J. Psychiatry 2008;165:1408-19), and bipolar disorder is associated with suicide and suicide attempts in both the general population and in veterans, Ms. Ballard said. However, no family-oriented interventions currently exists geared specifically toward suicide issues.
The researchers’ first step involved assessing FFT’s applicability when applied in an unmodified way. Among the 52 veterans who opted for FFT (about a third of veterans at risk for suicide at the time at the Denver VAMC), 90% were men, and their average age was 44 years old. In all, 42 (81%) of the veterans who participated in the FFT program had a diagnosis of bipolar disorder.
The patients participated in a total of 698 FFT sessions. Patients could bring whichever family members they wanted. In 66% of sessions a spouse was present, in 25% of sessions a mother attended, and in 6% of sessions a father attended.
Suicide-related thoughts or behaviors came up during 55 of the 698 sessions (8%), but other thoughts or behaviors considered to be suicide risk factors occurred during 540 (77%) of the sessions. The FFT sessions were not designed to elicit references to suicide, and suicide was not brought up by the therapists who ran the FFT sessions, Ms. Ballard said.
Future work might involve an assessment of the impact of FFT on suicide risk, with a more systematic measure of suicidal thoughts and behaviors before and after the FFT interventions, she said.
Ms. Ballard had no disclosures.