Comparing Suicide Rates for Cognitive Processing Therapy Versus Prolonged Exposure Therapy for Posttraumatic Stress...

Area of Science:

• Psychiatry
• Clinical Psychology
• Public Health

Background:

• Posttraumatic stress disorder (PTSD) is a significant public health concern associated with increased suicide risk.
• Evidence-based psychotherapies (EBPs) like cognitive processing therapy (CPT) and prolonged exposure (PE) are recommended for PTSD treatment.
• Understanding the comparative effectiveness of different EBPs on critical outcomes like suicide mortality is crucial for clinical practice and patient safety.

Purpose of the Study:

• To compare suicide mortality rates between patients with PTSD treated with CPT versus PE.
• To investigate the impact of two leading EBPs on suicide risk in a large veteran population.

Main Methods:

• A retrospective cohort study of U.S. Department of Veterans Affairs patients diagnosed with PTSD who received CPT or PE between 2009 and 2019.
• Suicide mortality was the primary outcome, analyzed using standard adjustment and instrumental variable (IV) methods, leveraging regional variation in EBP delivery.
• A total of 62,686 patients were included, with a median follow-up of 6 years.

Main Results:

• There were 136 deaths by suicide observed during the follow-up period.
• Suicide mortality rates per 100,000 person-years were 38.3 for CPT and 32.4 for PE.
• Statistical analyses, including IV approaches, did not reveal a significant difference in suicide mortality between the CPT and PE groups.

Conclusions:

• Neither cognitive processing therapy (CPT) nor prolonged exposure (PE) demonstrated a statistically significant difference in reducing suicide mortality among PTSD patients.
• Current evidence-based treatments for PTSD may not be sufficient to achieve a substantial relative decrease in suicide risk.
• Development of more effective PTSD interventions with higher remission rates is needed to better address suicide risk.