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Effects of prolonged exposure and virtual reality exposure on suicidal ideation in active duty soldiers: An examination of potential mechanisms.
J Psychiatr Res. 2018 08; 103:69-74.JP

Abstract

OBJECTIVE

The current study sought to investigate the effects of exposure therapy on suicidal ideation (SI), as well as potential mechanistic pathways of SI reduction among active duty military personnel.

METHODS

Active duty army soldiers (N = 162) were recruited from a military base in the U.S. and were enrolled in a randomized clinical trial comparing Prolonged Exposure (PE), Virtual Reality Exposure (VRE), and a wait-list control for the treatment of posttraumatic stress disorder (PTSD) stemming from deployments to Iraq or Afghanistan. PTSD diagnosis followed DSM-IV-TR criteria. Outcome measures were assessed via self-report and clinician interview. PTSD symptoms, depressive symptoms, and SI were included in an autoregressive cross-lagged panel model to examine mechanistic pathways.

RESULTS

Analyses revealed that PE/VRE had a lower probability of post-treatment suicidal ideation (OR = 0.23, 95% CI [0.06, 0.86]) compared to the waitlist control. Mediation analyses revealed a significant indirect effect from treatment condition to post-treatment PTSD symptoms through mid-treatment SI (Estimate = -1.420, 95% CI -3.559, -0.223]). Baseline suicidal ideation did not interact with treatment condition to predict PTSD symptom change at mid-treatment (p = .231) or post-treatment (p = .672).

CONCLUSION

PE/VRE successfully reduced SI, and the presence of SI at baseline did not affect PTSD symptom reduction, promoting the utility of using PE/VRE to address suicidality among individuals with PTSD. Mediation analyses suggest that reductions in SI were achieved early in treatment.

Authors+Show Affiliations

VA Puget Sound Health Care System, Tacoma/Seattle, WA, USA; University of Washington School of Medicine, Seattle, WA, USA.Defense Health Agency, Psychological Health Center of Excellence, Tacoma, WA, USA.VA Puget Sound Health Care System, Tacoma/Seattle, WA, USA; University of Washington School of Medicine, Seattle, WA, USA. Electronic address: Greg.Reger@va.gov.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

29783077

Citation

Norr, Aaron M., et al. "Effects of Prolonged Exposure and Virtual Reality Exposure On Suicidal Ideation in Active Duty Soldiers: an Examination of Potential Mechanisms." Journal of Psychiatric Research, vol. 103, 2018, pp. 69-74.
Norr AM, Smolenski DJ, Reger GM. Effects of prolonged exposure and virtual reality exposure on suicidal ideation in active duty soldiers: An examination of potential mechanisms. J Psychiatr Res. 2018;103:69-74.
Norr, A. M., Smolenski, D. J., & Reger, G. M. (2018). Effects of prolonged exposure and virtual reality exposure on suicidal ideation in active duty soldiers: An examination of potential mechanisms. Journal of Psychiatric Research, 103, 69-74. https://doi.org/10.1016/j.jpsychires.2018.05.009
Norr AM, Smolenski DJ, Reger GM. Effects of Prolonged Exposure and Virtual Reality Exposure On Suicidal Ideation in Active Duty Soldiers: an Examination of Potential Mechanisms. J Psychiatr Res. 2018;103:69-74. PubMed PMID: 29783077.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of prolonged exposure and virtual reality exposure on suicidal ideation in active duty soldiers: An examination of potential mechanisms. AU - Norr,Aaron M, AU - Smolenski,Derek J, AU - Reger,Greg M, Y1 - 2018/05/12/ PY - 2018/02/16/received PY - 2018/04/19/revised PY - 2018/05/11/accepted PY - 2018/5/22/pubmed PY - 2019/9/4/medline PY - 2018/5/22/entrez KW - Posttraumatic stress disorder KW - Prolonged exposure KW - Suicidal ideation KW - Suicide KW - Virtual reality SP - 69 EP - 74 JF - Journal of psychiatric research JO - J Psychiatr Res VL - 103 N2 - OBJECTIVE: The current study sought to investigate the effects of exposure therapy on suicidal ideation (SI), as well as potential mechanistic pathways of SI reduction among active duty military personnel. METHODS: Active duty army soldiers (N = 162) were recruited from a military base in the U.S. and were enrolled in a randomized clinical trial comparing Prolonged Exposure (PE), Virtual Reality Exposure (VRE), and a wait-list control for the treatment of posttraumatic stress disorder (PTSD) stemming from deployments to Iraq or Afghanistan. PTSD diagnosis followed DSM-IV-TR criteria. Outcome measures were assessed via self-report and clinician interview. PTSD symptoms, depressive symptoms, and SI were included in an autoregressive cross-lagged panel model to examine mechanistic pathways. RESULTS: Analyses revealed that PE/VRE had a lower probability of post-treatment suicidal ideation (OR = 0.23, 95% CI [0.06, 0.86]) compared to the waitlist control. Mediation analyses revealed a significant indirect effect from treatment condition to post-treatment PTSD symptoms through mid-treatment SI (Estimate = -1.420, 95% CI -3.559, -0.223]). Baseline suicidal ideation did not interact with treatment condition to predict PTSD symptom change at mid-treatment (p = .231) or post-treatment (p = .672). CONCLUSION: PE/VRE successfully reduced SI, and the presence of SI at baseline did not affect PTSD symptom reduction, promoting the utility of using PE/VRE to address suicidality among individuals with PTSD. Mediation analyses suggest that reductions in SI were achieved early in treatment. SN - 1879-1379 UR - https://www.unboundmedicine.com/medline/citation/29783077/Effects_of_prolonged_exposure_and_virtual_reality_exposure_on_suicidal_ideation_in_active_duty_soldiers:_An_examination_of_potential_mechanisms_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3956(18)30184-5 DB - PRIME DP - Unbound Medicine ER -