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Improving public health approaches to suicide prevention requires scalable evidence-based interventions that can be easily disseminated. Given empirical data supporting the association between insomnia and suicide risk, internet-delivered insomnia interventions are promising candidates to meet this need. The purpose of this study was to examine whether an unguided internet-delivered cognitive-behavioral therapy for insomnia (iCBT-I) improved insomnia severity, suicidal ideation (SI), and suicide risk correlates (depression, post-traumatic stress disorder, anxiety, hostility, belongingness, hopelessness, agitation, irritability, concentration) in a sample of veterans. Secondary data analysis of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans (n = 50) with clinically significant insomnia and elevated SI drawn from a larger randomized controlled trial (RCT) of an iCBT-I, Sleep Healthy Using the Internet (SHUTi). Two-sample t -tests or Wilcoxon rank sum tests were used to evaluate between-group differences (SHUTi vs. Insomnia Education Website control) in symptom improvement from baseline to post-intervention. SHUTi participants experienced a significant improvement in insomnia severity (P <.001; d = −1.08) and a non-significant with small (subthreshold medium) effect size reduction of SI (P =.17, d = 0.40), compared to control participants. Significant improvement in hopelessness was observed (medium effect size), with non-significant small to medium effect size reductions in most remaining suicide risk correlates. Self-administered iCBT-I was associated with improvements in insomnia severity in veterans at elevated risk for suicide. These preliminary findings suggest that SI and suicide risk correlates may improve following an iCBT-I intervention, demonstrating the need for future well-powered iCBT-I RCTs targeted for populations at elevated suicide risk. [ABSTRACT FROM AUTHOR]

Background: Computerized cognitive behavioral therapies (cCBTs) have been developed to deliver efficient, evidence-based treatment for depression and other mental health conditions. Beating the Blues (BtB) is one of the most empirically supported cCBTs for depression. The previous trial of BtB with veterans included regular guidance by health care personnel, which increased the complexity and cost of the intervention. Objective: This study, conducted by researchers at a Veterans Affairs Medical Center, aims to test the acceptability and feasibility of unguided cCBT for depression among US military veterans. Methods: To examine the acceptability of BtB delivered without additional peer or other mental health care provider support, a before-and-after trial was conducted among United States (US) military veterans experiencing mild to moderate depressive symptoms. The feasibility of the study design for a future efficacy trial was also evaluated. Results: In total, 49 veterans completed preintervention assessments and received access to BtB, and 29 participants completed all postintervention assessments. The predetermined acceptability criterion for the intervention was met. Although the predetermined feasibility criteria regarding screening eligibility rate, number of BtB modules completed, and completion of a posttreatment assessment were not met, the results were comparable with those of other cCBT studies. Conclusions: This is the first study among US military veterans to demonstrate support for the implementation of cCBT for depression without the assistance of a mental health professional or a peer support specialist, suggesting that stand-alone computer-aided interventions may be viable. Ideas for improving feasibility in future trials based on this study are discussed. [ABSTRACT FROM AUTHOR]

Objective: We examined Veterans' perspectives on discussing moral injury in veterans affairs (VA) evidence‐based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) and other VA treatment. Methods: Fourteen male warzone veterans (ages 25–74) who completed an EBP for PTSD within the past year participated in semistructured interviews related to discussing moral injury in VA treatment (e.g., EBPs for PTSD, chaplaincy). Qualitative interviews were evaluated using a thematic analysis. Results: Four themes were identified; moral injury is often not identified or discussed during therapy, therapeutic relationships can promote or inhibit discussion of moral injury, treatment has limited impact on moral injury, and it is difficult to cope with moral injury even after treatment. Conclusion: The majority of Veterans interviewed identified moral injury persisting within a year of completing a PTSD EBP. These findings highlight the value of asking about, assessing, and treating moral injury in Veterans. Our results suggest the importance of developing specific moral injury interventions for warzone Veterans. [ABSTRACT FROM AUTHOR]

The limitations of self-report confine clinicians' ability to accurately predict suicides and suicide attempts (SAs). Behavioral assessments (e.g., Death Implicit Association Test [IAT]) may be a means of supplementing self-report and clinician prediction.Objective: The authors aimed to build and test a predictive model of SAs that included established risk factors and measures of suicide risk, and Death IAT scores. The authors also sought to test the predictive validity of the SA model among subgroups of Veterans with and without PTSD.Method: Participants included 166 psychiatrically hospitalized Veterans.Results: A model that included patient prediction, age, and Death IAT scores improved upon clinician prediction of SAs during the six-month follow-up (C-statistic for clinician prediction = 73.6, 95% CI [62.9, 84.4] and C-statistic for model = 82.8, 95% CI [74.6, 91.0]). The model was tested in subgroups of Veterans with and without PTSD. Among Veterans without PTSD, the Death IAT and patient prediction predicted SAs above and beyond clinician prediction, while these variables did not significantly improve prediction among Veterans with PTSD (C-statistic for no-PTSD = 91.3, 95% CI [80.6, 1.00]; C-statistic for PTSD = 86.8, 95% CI [76.8, 96.8]). Building a separate model for Veterans with PTSD did not improve upon clinician prediction.Conclusions: Findings indicate that predictive models may bolster clinician prediction of SAs and that predictors may differ for Veterans with PTSD. [ABSTRACT FROM AUTHOR]