Effectiveness of Complementary and Integrative Approaches in Promoting Engagement and Overall Wellness Toward Suicide Prevention in Veterans

Amanda Vitale, Lauren Byma, Shengnan Sun, Evan Podolak, Zhaoyu Wang, Sharon Alter, Hanga Galfalvy, Joseph Geraci, Erik Langhoff, Heidi Klingbeil, Rachel Yehuda, Fatemeh Haghighi, Ann Feder, Amanda Vitale, Lauren Byma, Shengnan Sun, Evan Podolak, Zhaoyu Wang, Sharon Alter, Hanga Galfalvy, Joseph Geraci, Erik Langhoff, Heidi Klingbeil, Rachel Yehuda, Fatemeh Haghighi, Ann Feder

Abstract

Objective: Suicide is a major public health problem, specifically among U.S. veterans, who do not consistently engage in mental health services, often citing stigma as a barrier. Complementary and Integrative Health (CIH) interventions are promising alternatives in promoting patient engagement and further, they may play a critical role in transitioning people into mental health care. Toward this goal, the Resilience and Wellness Center (RWC) was developed to break through the stigma barrier by addressing risk factors of suicide through multimodal CIH interventions via cohort design, promoting social connectedness and accountability among participants. Design: This is a program evaluation study at a large urban VA medical center, where assessments were evaluated from pre- to post-program completion to determine the effectiveness of an intensive multimodal CIH 4-week group outpatient intervention for suicide prevention. Outcome measures: Primary outcomes measured included group connectedness, severity of depression and hopelessness symptoms, suicidal ideation, sleep quality, and diet. Secondary outcomes included measures of post-traumatic stress disorder (PTSD), generalized anxiety severity stress/coping skills, pain, and fatigue. Results: The RWC showed high participant engagement, with an 84%-95% attendance engagement rate depending on suicide risk history. Data from 15 cohorts (N = 126) demonstrate favorable outcomes associated with participation in this comprehensive program, as evidenced by a reduction in suicidal ideation, depression, and hopelessness, but not sleep quality and diet. In addition, in a subset of veterans with a history of suicidal ideation or attempt, significant improvements were noted in pain, PTSD/anxiety symptoms, and stress coping measures. Conclusions: The RWC shows that an intensive complement of CIH interventions is associated with a significant improvement with high veteran engagement. Findings from this program evaluation study can be used to aid health care systems and their providers in determining whether or not to utilize such multimodal CIH integrated interventions as an effective treatment for at-risk populations as a part of suicide prevention efforts.

Keywords: complementary and integrative health; depression; meditation; mind–body; nutrition; sleep; suicide prevention.

Conflict of interest statement

The authors have no disclosures or conflicts of interest.

Figures

FIG. 1.
FIG. 1.
Age and sex distribution of RWC program participants across all 15 cohorts with 87 males (in blue) and 39 females (in red), separated by a lifetime history of suicide. The majority of at-risk veterans, 54% with a suicide history (ideation or attempt, SI/SA) are in the 45–64 age group, and secondarily 27% are in the under 45 age group. RWC, Resilience and Wellness Center; SA, suicide attempter; SI, suicide ideator. Color images are available online.
FIG. 2.
FIG. 2.
Mental health outcomes, including depressive symptoms (assessed by PHQ-9 and BDI) and hopelessness (assessed by BHS) shown by group, with ideators (SI), attempters (SA), and those with no suicide history (No SI/SA). Left panels show unwinsorized scores pre- versus post-RWC program completion, where clinically relevant moderate depressive and hopelessness symptoms are demarcated by horizontal lines at 10, 20, and 9 for PHQ-9, BDI, and BHS, respectively. Right plots show intraindividual differences in scores [delta = (post − pre)] values. BDI, Beck Depression Inventory; BHS, Beck Hopelessness Scale; PHQ-9, Patient Health Questionnaire-9. Color images are available online.
FIG. 3.
FIG. 3.
Pain outcomes assessed by the DVPRS shown by group, with ideators (SI; n = 24), attempters (SA; n = 16), and those with no suicide history (No SI/SA; n = 30). Left panels show unwinsorized scores pre- versus post-RWC program completion, where clinically relevant moderate pain symptoms are demarcated by horizontal lines at 4 for the DVPRS.Right plots show intraindividual differences in scores [delta = (post − pre)] values. DVPRS, Defense Veterans Pain Rating Scale. Color images are available online.
FIG. 4.
FIG. 4.
Percentage of patients who showed improvement in no-show rates across services comparing 3 months pre- and 3 months post-RWC program completion. (MH, mental health; PC, primary care; SP, specialty services, e.g., dermatology, rehabilitation medicine, cardiology, dental care, etc.). Color images are available online.

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