Functional outcomes following psychotherapy for elevated suicide risk: Secondary analysis of a randomized controlled...

Suicidal thoughts and behaviors are associated with severe impairment in daily functioning and reduced quality of life, yet clinical trials of suicide-focused psychotherapies have focused almost exclusively on suicidal ideation and behavior as outcomes. This study examined change in patient-reported functional outcomes (pain interference, physical functioning, and social functioning) during two evidence-based psychotherapy treatments for elevated suicide risk.

This is a secondary analysis of a two-arm parallel randomized controlled trial comparing Brief Cognitive Behavioral Therapy (BCBT) and Present-Centered Therapy (PCT) delivered to 85 adults with active suicidal ideation or a recent suicide attempt. Physical functioning, pain interference, and ability to participate in social roles and activities were assessed using the 43-item Patient Reported Outcomes Measurement Information System (PROMIS-43) at baseline and at 3, 6, 9, and 12 months. Generalized estimating equations were used to estimate change over time and between-group differences. Clinically meaningful change was defined as ≥ 5-point PROMIS-43 T-score change [44].

At baseline, functional impairment was prevalent: 50.0%, 65.9%, and 81.0% of patients reported at least mild impairment in physical functioning, pain interference, and social functioning, respectively. Mean scores improved significantly over time across all three domains (all p's ≤ 0.028), with the largest gains occurring in the first three months. Trajectories did not differ significantly between treatment groups. By the end of follow-up, more BCBT than PCT patients had returned to within-normal-limits functioning for pain interference (58.9% vs. 42.5%) and social functioning (58.4% vs. 45.4%). Rates of meaningful improvement substantially exceeded rates of meaningful worsening for pain interference and social functioning in both treatments.

Suicide-focused psychotherapy is associated with clinically meaningful improvements in pain interference and social functioning, with more modest gains in physical functioning. These findings support expanding outcome assessment in suicidal populations beyond ideation and symptoms to include functional domains central to quality of life.