Department of Veterans Affairs Office of Mental Health and Suicide Prevention, Washington, District of Columbia; Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina.
Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina.
Womens Health Issues. 2019 Jun 25;29 Suppl 1:S103-S111. doi: 10.1016/j.whi.2019.04.013.
Although most suicide-related deaths occur among male veterans, women veterans are dying by suicide in increasing numbers. Identifying and increasing access to effective treatments is imperative for Department of Veterans Affairs suicide prevention efforts. We examined the impact of evidence-based psychotherapies for depression on suicidal ideation and the role of gender and treatment type in patients' responses to treatment.
Clinicians receiving case consultation in interpersonal psychotherapy, cognitive-behavioral therapy for depression, and acceptance and commitment therapy for depression submitted data on depressive symptoms and suicidal ideation while treating veterans with depression.
Suicidal ideation was reduced across time in all three treatments. A main effect for wave was associated with statistically significant decreases in severity of suicidal ideation, χ (2) = 224.01, p = .0001, and a subsequent test of the Gender × Wave interaction was associated with differentially larger decreases in ideation among women veterans, χ (2) = 9.26, p = .001. Within gender-stratified subsamples, a statistically significant Treatment × Time interaction was found for male veterans, χ (4) = 16.82, p = .002, with levels of ideation significantly decreased at waves 2 and 3 in interpersonal psychotherapy and cognitive-behavioral therapy for depression relative to acceptance and commitment therapy for depression; the Treatment × Wave interaction within the female subsample was not statistically significant, χ (4) = 3.41, p = .492.
This analysis demonstrates the efficacy of each of the three tested evidence-based psychotherapies for depression as a means of decreasing suicidal ideation, especially in women veterans. For male veterans, decreases in suicidal ideation were significantly greater in interpersonal psychotherapy and cognitive-behavioral therapy for depression relative to acceptance and commitment therapy for depression.
尽管大多数与自杀相关的死亡发生在男性退伍军人中，但女性退伍军人的自杀率正在不断上升。为了推进退伍军人事务部的自杀预防工作，确定并增加有效的治疗方法至关重要。我们研究了针对抑郁症的循证心理疗法对自杀意念的影响，以及性别和治疗类型在患者对治疗的反应中的作用。
接受人际心理治疗、认知行为疗法治疗抑郁症和接受接纳与承诺疗法治疗抑郁症的临床医生在治疗患有抑郁症的退伍军人时，提交了关于抑郁症状和自杀意念的数据。
所有三种治疗方法在随访期间自杀意念均有所减轻。波的主要效应与自杀意念严重程度的统计学显著下降相关，χ²(2)=224.01，p=.0001，随后对性别×波的交互作用进行检验，结果表明女性退伍军人的自杀意念下降幅度更大，χ²(2)=9.26，p=.001。在性别分层子样本中，男性退伍军人的治疗×时间交互作用具有统计学意义，χ²(4)=16.82，p=.002，与接纳与承诺疗法治疗抑郁症相比，人际心理治疗和认知行为疗法治疗抑郁症的自杀意念在第 2 波和第 3 波显著降低；女性子样本中的治疗×波交互作用无统计学意义，χ²(4)=3.41，p=.492。
这项分析表明，三种经过测试的循证心理疗法治疗抑郁症都具有降低自杀意念的疗效，尤其是对女性退伍军人。对于男性退伍军人，人际心理治疗和认知行为疗法治疗抑郁症的自杀意念降低幅度明显大于接纳与承诺疗法治疗抑郁症。
