Marianne Goodman

Objective: Suicide-specific group psychotherapy is a novel approach to suicide prevention with promising supporting data. However, limited research examines telehealth delivery for suicide-specific interventions. This study described treatment engagement and suicide-related coping (SRC) trajectories among Veterans receiving a group suicide safety planning intervention before and after a transition from in-person to telehealth delivery. Methods: Project Life Force (PLF) is a group suicide safety planning intervention evaluated within a randomized clinical trial. During the COVID-19 pandemic, PLF transitioned from in-person to telehealth, creating naturalistic pre-pandemic in-person and pandemic-era telehealth cohorts. This report focused on participants randomized to PLF and described treatment initiation, engagement, completion, and SRC trajectories across cohorts. Findings: : Baseline suicidal ideation and SRC were higher in the pre-pandemic in-person cohort than the pandemic-era telehealth cohort. The telehealth cohort showed higher rates of treatment initiation descriptively than the in-person cohort, while treatment engagement and completion among treatment initiators were more similar across delivery periods. Both cohorts showed improvement in SRC that was sustained over time. Conclusions: Elevated treatment initiation occurred with virtual delivery of PLF. Both pre-pandemic in-person and pandemic-era telehealth cohorts showed similar patterns of group engagement as well as development and sustainment of SRC over time. As telehealth can reduce barriers to care, these data lend support to the promise of virtual, group-based, suicide-related interventions. Since treatment modality was determined by the pandemic and not randomized, delivery context, cohort characteristics, and pandemic-related factors may have impacted observed patterns. Randomized studies comparing delivery modalities should clarify potential treatment modality differences.

Depressive symptoms and hopelessness are central to suicidal states and various psychiatric conditions. The Beck Depression Inventory-II and Beck Hopelessness Scale are widely used measures in clinical and research contexts to evaluate the severity of these conditions. Although both scales demonstrate strong psychometric properties for assessing between-person differences, their sensitivity to within-person variation across repeated measures has not been evaluated in psychiatric populations. Generalizability theory provides a framework to partition variance from multitime-point assessments into meaningful sources (i.e., person, time, item, and their interactions), enabling the estimation of two complementary reliability coefficients that we evaluated in the present study: reliability of individual differences in change (R_c), with fixed items and time, and reliability of within-person variation averaged across items, with time nested within persons (R_cn). Up to four waves of data across 1 year were collected from 157 treatment-seeking veterans at risk of suicide enrolled in a suicide safety planning randomized clinical trial. Variance decomposition analysis was conducted via crossed and nested multilevel models. Individual differences in change accounted for 15% of the variance for both measures (crossed design, N = 87), and within-person variation accounted for 17%-19% (nested design, N = 157). R_c and R_cn coefficients exceeded .80. These findings indicate that the Beck Depression Inventory-II and Beck Hopelessness Scale reliably capture individual differences in change and within-person variation of moderate magnitude in depressive and hopelessness symptoms. Future work should examine their sensitivity to change and variation across different contexts, timescales, and populations. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Background: Approximately 25% of combat veterans with posttraumatic stress disorder (PTSD) seek treatment for traumas involving potentially morally injurious events (PMIEs), which involve acts of commission, omission, or betrayal that deeply transgress one’s sense of right and wrong. The sequelae of exposure to PMIEs, called “moral injury,” are associated with functional and psychiatric impairment and disrupt veterans’ sense of identity and meaning, ability to connect with and trust others, and engender disturbing guilt, shame, rage, and disgust. Currently, no first-line treatments directly address moral injury, and evidence-based treatments for PTSD may be limited because they were derived from civilian contexts, poorly fit the war zone context, and do not allow veterans to discuss the details of the PMIEs with other veterans. Objective: We propose a depth-oriented group psychotherapy for morally injured US combat veterans. Its development is guided by user-centered design principles. Method: This research plan will use user-centered design methods that continuously gather user experiences during treatment development, with the goal of increased effectiveness and usability. Aim 1 is to discover user needs and preferences as well as treatment-engagement barriers and facilitators from the perspectives of PMIE-impacted veterans and the US Department of Veterans Affairs (VA) trauma clinicians (ie, mental health providers and chaplains) using semistructured qualitative interviews. Aim 2 is to design a treatment manual and refine it using feedback from veterans, VA clinicians and chaplains, and an expert clinical advisory board. Aim 3 is to conduct 2 rapid prototyping open trials (ie, tangibly testing treatment approaches using a prototype manual) with PMIE-impacted veterans (N=12) and iteratively revise the manual based on veteran, provider, and clinical expert panel feedback. We hypothesize that the treatment manual will meet usability, feasibility, learnability, and acceptability criteria. Results: This study was funded with a start date of November 2021. Participant recruitment for Aim 3 pilot trials began in October 2023 and ended in January 2025. We anticipate study data collection and primary data analysis to be completed in January and April 2026, respectively. Conclusions: This project aims to develop and pilot test a treatment manual for a depth-oriented group psychotherapy for moral injury. We anticipate that the manual will meet predetermined usability, feasibility, and acceptability criteria because we used user-centered design methods; if it does not, we are well-poised to revise the manual based on user feedback. Should primary outcomes be met, the next step will be to design and execute a parallel-group randomized controlled trial. We additionally plan to disseminate learnings about combat veteran and VA clinician needs, preferences, and barriers regarding moral injury group psychotherapy, which may inform treatment development efforts beyond this project and study team.

Importance: Novel evidence-based suicide-specific treatments are critical to addressing rising rates of suicide among veterans. Objective: To determine whether Project Life Force (PLF), a group intervention that augments suicide safety planning (SSP) with skills training, plus treatment as usual (TAU) delays or decreases suicidal behavior compared with TAU alone. Design, Setting, and Participants: This multisite randomized clinical trial, using intention-to-treat analyses, included veterans at high risk for suicide. Participants were recruited after psychiatric inpatient discharge or referral from 4 Veterans Health Administration outpatient care teams in hospitals in Pennsylvania, New York, and Texas between March 2018 and February 2024. Data were analyzed from April 2024 to October 2025. Intervention: PLF is a manualized, 10- to 12-session (75-90 minutes per session) group intervention combining SSP with distress tolerance, emotion regulation, and interpersonal skills training. Sessions cover each of the 6 SSP steps, health management, reasons for living, SSP accessibility, and a recap, with up to 4 optional booster sessions offered. All participants received TAU, constituting individual SSP and standard outpatient mental health care. Main Outcomes and Measures: The primary outcome was time in days to first suicidal behavior (aborted, interrupted, or actual attempts or suicide death) over 12 months, assessed using the Columbia Suicide Severity Rating Scale and chart review. Secondary outcomes over 12 months included self-report measures of hopelessness, depression, treatment use, attitudes toward help-seeking, and suicide-related coping. Results: A total of 207 participants (mean [SD] age, 46.1 [13.9] years; 178 male [86%]) were assessed at baseline and randomly assigned to PLF plus TAU (101 participants) or TAU alone (106 participants). Cox proportional hazards models showed no significant between-group difference in time to suicidal behavior; however, compared with TAU, PLF participants had a lower hazard of actual suicide attempts over 1 year (HR, 0.49; 95% CI, 0.26-0.92; P = .03). Secondary outcome analyses included data from 132 participants (64%) at posttreatment, 125 (60%) at month 6, and 130 (62%) at month 12. Treatment-by-time effects ranged from Cohen d = −0.03 to 0.35. Notably, PLF significantly improved suicide-related coping at posttreatment (estimate, 4.06; Cohen d , 0.21; P = .04) and month 6 (estimate, 5.36; Cohen d , 0.27; P = .007). No study-related adverse events occurred. Conclusions and Relevance: In this randomized clinical trial of 207 participants, PLF plus TAU did not change time to suicidal behavior but did increase time to actual suicide attempts and improve suicide-related coping, thereby enhancing SSP impact. Trial Registration: ClinicalTrials.gov Identifier: NCT03653637

Objective: Expectations about the future are central to theories of suicide. However, the clinical relevance of an individual's direct expectation of a future suicide attempt is not well understood. This study examined the correlates and prospective significance of expecting a future suicide attempt in a high‐risk cohort. Method: Veterans at high risk of suicide ( N = 126) were tracked for 365 days during a randomized clinical trial. Chi‐square tests and Wilcoxon rank‐sum tests were used for cross‐sectional comparisons and Cox proportional hazards regression was used for prospective prediction of suicidal behavior. Results: Veterans who expected a future suicide attempt had higher rates of preparation for suicide, recent suicidal behavior, and perceived access to a method and opportunity for suicide than those who did not expect one. Groups did not differ in hopelessness, positive and negative expectations toward the future, and perceived suicide‐related coping. Veterans who expected a suicide attempt had elevated risk of suicidal behavior. Conclusion: Risk factors differentiated Veterans who did and did not expect a future suicide attempt, yet this expectation predicted suicidal behavior independent of these factors. Research on how individuals anticipate their own suicidal behavior may clarify the transition from suicidal thoughts to behavior and facilitate suicide prevention.

Introduction: U.S. military veterans face a higher risk of suicide than the general population, underscoring the need to identify risk factors and refine intervention targets. Although loneliness has been associated to suicide risk in civilians, no comprehensive review has examined this relationship among veterans. This scoping review summarizes methods and findings on loneliness and suicide risk in U.S. veterans, emphasizing psychiatric and psychological correlates and potential mediators. Materials and Methods: PubMed, PsycINFO, Google Scholar, CINAHL, Scopus, and PTSDpubs were searched for empirical studies of U.S. veterans measuring loneliness and suicide risk. Results: Twenty studies met inclusion criteria. Ten found loneliness to be a significant predictor of suicide risk. Most relied on self-report measures of loneliness (n = 16) and suicide risk (n = 15), others used qualitative analysis of crisis line calls (n = 4) and medical record abstraction (n = 1). Nine studies examined additional psychological or psychiatric variables, but none tested them as mediators. Samples were predominantly male and older (age > 55), limiting generalizability. Conclusion: Loneliness and suicide risk are significantly related in U.S. veterans. However, research remains limited and reliant on retrospective self-reports, vulnerable to memory biases. Future research should examine other research methods and younger, diverse samples.

A suicide epidemic exists among young U.S. veterans, with risk especially elevated in the first year of transition for the 200,000 servicemembers exiting the military annually. The VA Veteran Sponsorship Initiative (VSI) is a public–private-partnership between federal and community partners that aims to decrease suicides by providing a VA-certified volunteer peer sponsor and connection to community services. Onward Ops is a key community-based national program that enrolls, matches and manages the relationship between servicemembers and sponsors. A prior randomized controlled trial showed that the effectiveness of community interventions can be enhanced when augmented by an Onward Ops sponsor. In preparation for national implementation, we conducted a quasi-experimental, matched-cohort pilot to evaluate the feasibility of an adapted VSI protocol and then assessed effectiveness. The adaptations were executed using the Framework for Reporting Adaptations and Modifications-Enhanced between April 2021 and April 2023. The formative results supported the feasibility of the adaptations to enable proactive enrollment on military installations and expand data infrastructure, partnerships, peer sponsors, and VA clinical services. We then assessed the effectiveness for outcomes not studied in the original VSI trial for active-duty soldiers who enrolled between April and December 2023. After nearest-neighbor matching, the sample included 551 VSI participants and 551 soldiers transitioning as usual. The point-probability contrast or risk differences from the conditional logistic regression model indicated that the VSI caused a statistically significant increase in VA primary care utilization of 0.198 and a statistically significant decrease in suicide attempts of −0.019, both assessed 10 months post-military discharge. The study demonstrated the utility of public–private-partnerships, peer-sponsorship programs and enhanced VA services to support servicemembers during transition.

Long COVID remains a pressing health concern among Americans, with current data suggesting that 45% of those infected by COVID-19 experience at least one symptom of Long COVID. Veterans are a particularly at-risk population due to their unique demographic characteristics and lived experiences. Despite this, there has been a lack of treatment development for Long COVID that targets mental health symptoms and is veteran specific. There is a need for effective treatments to help veterans cope with a Long COVID diagnosis and recovery. This quality improvement project aims to gain insight into the lived experiences and mental health needs of veterans with Long COVID to help inform future treatment development. A sample of 21 veterans (57% male, 67% Black, 43% Hispanic) participated in qualitative interviews where they were asked 23 questions about their experiences living with Long COVID and seeking medical treatment, as well as their ongoing mental health needs. Qualitative data were extracted from these interviews and analyzed. Four main themes were identified: interpersonal concerns and challenges with social interaction; difficulties with day-to-day living; barriers and facilitators to accessing medical treatment; and mental health effects and attitudes toward psychotherapy. Veterans described significant impairments in functioning, as well as feelings of isolation and loneliness. These findings demonstrate the need for a psychotherapeutic intervention that can facilitate interpersonal connection, improve functioning, and decrease psychiatric symptoms. (PsycInfo Database Record (c) 2026 APA, all rights reserved).