Reducing Suicide Risk in Older Veterans Using Problem Solving Therapy

Who can take part

• >= 55 years old
• SI (past month) on the C-SSRS; No SI or imminent risk (will be excluded); Eligibility now includes non-specific active suicidal thoughts to active SI with some planning (on C-SSRS item 3: "Have you been thinking about how you might do this") and/or some intent to act (on C-SSRS item 4: "Have you had these thoughts and had some intention of acting on them?") provided that those endorsing item 4 have an established relationship with a psychiatrist aware of this intent level (who is not also performing psychotherapy); Those endorsing C-SSRS item 5: "Do you intend to carry out this plan?" would be considered at imminent risk and excluded
• Presence of DSM-5 depressive disorder or anxiety disorder, specified or unspecified, or PTSD or subthreshold PTSD
• No diagnosis of dementia; evidence that cognitive impairment is not indicative of possible dementia based on a negative cognitive telephone screen (<10 errors on the Blessed cognitive screen)
• No diagnosis on MINI or medical record for psychotic symptoms or disorders, bipolar disorder, or severe OCD (mild or moderate OCD will be eligible)
• No history of head injury past 12 months
• No severe or unstable chronic medical illness or other severe or unstable respiratory, cardiovascular, neurologic, hepatic, hematopoietic, gastrointestinal or metabolic dysfunction
• AUDIT Total score <15 for men or <13 for women (no current alcohol use disorder)
• No substance use disorder of any type for illicit substances, no moderate or severe substance use disorder for cannabis/marijuana - on the MINI
• No prominent homicidal ideation
• English language proficiency to engage in treatment
• Sensory abilities sufficiently intact to engage in assessment and treatment
• Not currently enrolled in individual psychotherapy for a mental health issue. Participants who are receiving mental health care are eligible if their current care includes treatment from a psychiatrist, supportive therapy, peer counseling or support, or participating in psychoeducational groups
• No current prescription for anti-psychotics if prescribed for a psychotic disorder; Anti-psychotics for depression without psychosis are eligible; Psychotropic medications (e.g., SSRIs) are also eligible

Who cannot take part

• Currently enrolled in individual psychotherapy for a mental health issue. Participants who are receiving mental health care are eligible if their current care includes treatment from a psychiatrist, supportive therapy, peer counseling or support, or participating in psychoeducational groups
• No DSM-5 depressive disorder or anxiety disorder, or PTSD or subthreshold PTSD
• Diagnosis of dementia; evidence that cognitive impairment is indicative of possible dementia based on a positive cognitive telephone screen (>=10 errors on the Blessed cognitive screen)
• Diagnosis on MINI or medical record for psychotic symptoms or disorders, bipolar disorder, or severe OCD (mild or moderate OCD will be eligible)
• History of head injury past 12 months
• Severe or unstable chronic medical illness or other severe or unstable respiratory, cardiovascular, neurologic, hepatic, hematopoietic, gastrointestinal or metabolic dysfunction
• AUDIT Total score >14 for men or >12 for women (no current alcohol use disorder)
• Substance use disorder of any type for illicit substances, moderate or severe substance use disorder for cannabis/marijuana - on the MINI
• Current prescription for anti-psychotics if prescribed for a psychotic disorder, and not prescribed for depression without psychosis
• < 55 years old
• No SI (past month) or imminent risk on the C-SSRS will be excluded. Those endorsing C-SSRS item 5: "Do you intend to carry out this plan?" would be considered at imminent risk and excluded
• Prominent homicidal ideation
• Lacking English language proficiency to engage in treatment
• Sensory abilities not sufficiently intact to engage in assessment and treatment