Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA.
Gen Hosp Psychiatry. 2019 May-Jun;58:27-32. doi: 10.1016/j.genhosppsych.2019.02.002. Epub 2019 Feb 8.
We evaluated the effect of brief cognitive behavioral therapy (bCBT) on suicidal ideation among medically ill veterans receiving mental health treatment in primary care.
Secondary analysis was conducted on data collected during a multisite, patient-randomized trial investigating the impact of bCBT (n = 180) on depression and anxiety symptoms, relative to enhanced usual care (EUC; n = 122), in patients with congestive heart failure and/or chronic obstructive pulmonary disease. BCBT was delivered by primary care mental health providers over 4 months, with follow-up posttreatment assessments of suicidal ideation, measured by the Patient Health Questionnaire-9 (item 9) at 4, 8, and 12 months. Suicidal ideation was the primary outcome examined in the current analysis. Generalized estimating equations modeling suicidal ideation were used to compare the study arms.
Participants receiving bCBT were less likely to have high suicidal ideation than participants receiving EUC posttreatment and at 8-month follow-up after accounting for baseline suicidal ideation. Within-group comparisons suggest participants receiving bCBT were less likely to have high suicidal ideation at 4, 8, and 12 months when compared with baseline. High suicidal ideation for EUC participants did not differ at 4, or 8 months, but they were less likely to have high suicidal ideation at 12 months.
bCBT in primary care reduces suicidal ideation and may help prevent future suicidal ideation.
我们评估了简短认知行为疗法（bCBT）对接受初级保健中心精神卫生治疗的患病退伍军人自杀意念的影响。
对一项多地点、患者随机试验中收集的数据进行二次分析，该试验调查了 bCBT（n=180）对充血性心力衰竭和/或慢性阻塞性肺疾病患者的抑郁和焦虑症状的影响，与增强的常规护理（EUC；n=122）相比。bCBT 由初级保健心理健康提供者在 4 个月内提供，在治疗后和 4、8 和 12 个月时通过患者健康问卷-9（第 9 项）评估自杀意念。自杀意念是当前分析中检查的主要结果。使用广义估计方程模型来比较研究组。
接受 bCBT 的参与者在治疗后和 8 个月随访时，与接受 EUC 的参与者相比，自杀意念较高的可能性较小，且在考虑到基线自杀意念后也是如此。组内比较表明，与基线相比，接受 bCBT 的参与者在 4、8 和 12 个月时自杀意念较高的可能性较小。EUC 参与者的高自杀意念在 4 个月或 8 个月时没有差异，但在 12 个月时自杀意念较低的可能性较小。
初级保健中的 bCBT 可降低自杀意念，并可能有助于预防未来的自杀意念。
