4 - (SYM 36) Treatment for Relationships and Safety Together (TR&ST): Development and Pilot Examination

Background: Suicide prevention among veterans is the VA’s top clinical priority. Recent research supports the interpersonal nature of suicidality, suggesting that a supportive intimate relationship may reduce suicide risk, while a distressed relationship may increase risk. However, couple-based suicide interventions are limited within the VA. To fill this gap, a Career Development Award (CDA) is currently supporting the development and RCT of Treatment for Relationships and Safety Together (TR&ST), an 11-session intervention focused on emotion regulation, communication about suicide and relationship distress, and conjoint cognitive work focused on modifying maladaptive thoughts.

Method: In two sequential pilot studies, 12 couples participated in TR&ST. All couples included a veteran who reported active suicidal ideation in the past 1 month and/or a suicide attempt in the prior 3 months. Couples completed baseline, weekly, post-treatment, and 3-month follow-up measures of relationship satisfaction and suicidal ideation, as well as qualitative interviews after each treatment module. Latent growth curve models were used to assess weekly change during treatment and maintenance of change was evaluated with t-tests from post-treatment to 3-month follow-up. A RCT is currently underway to test the preliminary efficacy of TR&ST.

Results: Weekly growth curve results indicated that veteran suicidal ideation significantly decreased (p < .001; large effect, g = 1.18). Veteran and partner weekly relationship satisfaction each improved 5 points on the 8-item Couple Satisfaction Index (CSI), however this change was not significant likely due to sample size. Symptoms did not significantly change from post-treatment to 3-month follow-up providing some indication of maintenance. Qualitative feedback indicated that couples were using skills for their expected purposes and experiencing benefit. Couples desired increased focus on relationship issues. Feedback informed protocol modification decisions and learning points will be discussed.

Discussion: TR&ST data suggest that veteran couples are engaged in and benefiting from this couple-based suicide intervention. Treating suicide and relationship functioning together may enhance treatment outcomes.