Ohio State University’s STRIVE Program Finds New Ways to Reduce Suicide Risk Among Veterans

The latest findings from the Suicide and Trauma Reduction Initiative for Veterans (STRIVE) at Ohio State University, led by Justin C. Baker, PhD, ABPP, have shed new light on the most effective interventions for reducing suicide risk among Veterans. 

The psychiatric community has long grappled with the link between posttraumatic stress disorder (PTSD) and suicidal ideation in Veterans. A research study from The Ohio State University Wexner Medical Center and College of Medicine offers new insights on this complex topic.

Historically, PTSD – initially termed shell shock syndrome, combat fatigue, or the "thousand-yard stare," – has been a challenge since World War I. The term PTSD was officially adopted in 1980. The connection between PTSD and suicidal thoughts has remained a pressing concern. The 2022 National Veteran Suicide Prevention Annual Report revealed a staggering unadjusted suicide rate of 31.7 per 100,000 for American Veterans in 2020 – almost triple the rate of 12.6 per 100,000 for non-Veterans.

To address this, Ohio State established the Suicide and Trauma Reduction Initiative for Veterans (STRIVE), a unique research institute dedicated to developing, refining, and treating suicide, trauma, and gun-related violence risk reduction.  The effort was led by three Veterans and clinicians: Justin C. Baker, PsyD; Craig Bryan, PsyD; and AnnaBelle Bryan, MS.

Recognizing the need for swift intervention, STRIVE introduced a compressed treatment model. Unlike traditional weekly 1-hour cognitive processing therapy (CPT) sessions conducted over 10 to 14 weeks, STRIVE consolidated 12 sessions into 10 daily sessions, so that treatment could be completed in just two weeks. This approach proved to be as effective, and potentially more effective, than the traditional model.   By speeding up the therapy process, STRIVE found it could provide quicker relief to patients, while addressing symptoms of avoidance – a key element of PTSD.

STRIVE also pioneered the simultaneous implementation of multiple treatments, combining CPT with a crisis response plan (CRP). The CRP, developed collaboratively between patients and providers, reduced suicide attempts by 76%. Contrary to past beliefs that addressing PTSD and suicidal thoughts concurrently might exacerbate the situation, STRIVE's approach effectively managed both, leading to improved outcomes for both patient groups.

Unlike previous PTSD studies that excluded high-risk patients, STRIVE deliberately included them to better understand and treat this vulnerable population. By avoiding preparatory sessions and initiating intensive treatment immediately, STRIVE minimized delays and achieved the low dropout rate of about 10%.

Another difference:  STRIVE equipped all participants, regardless of their initial disclosure of suicidal thoughts, with a CRP. This tool proved invaluable for patients who developed suicidal thoughts later on, providing them with coping strategies if thoughts of suicide surfaced post- treatment.

In conclusion, STRIVE's study highlights the effectiveness of reducing suicidal ideation by providing a CRP to patients receiving PTSD treatment in outpatient clinical settings. As research progresses, the hope is to further refine treatments and interventions, reducing suicidal ideation and suicide attempts across diverse patient subgroups and clinical settings.  https://medicine.osu.edu/departments/psychiatry-and-behavioral-health/strive