Assessment and Treatment of Depression and Suicidal Behavior Associated with Military Service: An Overview

 
Description:

This training module outlines the rates of depression and suicide in the civilian, military, and veteran population and provides information about the etiology of depression and suicide.  A body of nomenclature for labeling suicidal related behavior is provided, and risk factors, warning signs, and protective factors related to suicide are covered.  Next, strategies for assessing depression and suicidal behavior are addressed, and specific psychometric tools are provided.  Components of a thorough clinical interview to assess suicide risk are identified along with a theory which addresses the fluctuating nature of suicide risk.  Treatments consistent with the VA/DoD Clinical Practice Guidelines to address depression and suicidal behavior are provided, with emphasis given to Cognitive and Behavioral Therapy.  A specific treatment protocol for treating suicidal behavior is outlined in detail.

Learning Objectives:

By the end of the workshop, participants will be able to:

  1. Discuss the prevalence of depression and suicide in the military population.
  2. Describe the correct nomenclature for suicidal and related behaviors.
  3. Identify strategies for screening and assessing military clients for depression and suicidal behaviors.
  4. Review effective therapies for treating military clients with depression and those displaying suicidal behaviors.

Outline:

  1. Dysfunctional Therapist Cognitions about Treating Depressed and Suicidal Patients
  2. Rates of Depression
    1. In Service Members
    2. In Veterans 
  3. Scope of Suicide Problem
    1. Suicide>homicide or war-related deaths
    2. Global scope of the problem
    3. National (US) significance
  4. Military and Veteran Suicide Deaths

a. By component and calendar year
b. By service and component vs. general population
c. Veterans per year

       V.  Etiology of Depression

  1. How it relates to Service Members
  2. How warriors see the world differently
  3. Mental health culture vs military culture
  4. Myths about depression
  1. Joiner’s Interpersonal Theory of Suicide

    1. Thwarted belonging
    2. Burdensomeness
    3. Acquired ability
    4. Empirical support for Interpersonal Theory of Suicide
  2. Depressive Spectrum Disorders: Diagnostic Criteria
    1. Various disorders
    2. Symptom criteria for Major Depressive Disorder
    3. Adjustment Disorder with Depressed Mood
    4. Overlap between depression and trauma/PTSD reactions
  3. Nomenclature for Suicidal and Related Behaviors
    1. Self-directed violence terminology
    2. Flowchart for self-directed violence definitions
    3. Self-directed violence terminology, continued
  4. Suicide Prevention
    1. Video, Shoulder to Shoulder: Finding Strength and Hope Together, demonstrating a DoD suicide prevention effort
    2. Levels of prevention: primary, secondary, and tertiary
    3. Goal of suicide prevention: increase protective factors and decrease risk factors
  5. Suicide Risk Factors, Warning Signs and Protective Factors
    1. Conceptual model of suicide risk
    2. Suicide warning signs
    3. Suicide risk factors
    4. Military suicide risk factors
    5. Mental health diagnostic contributors to suicide risk among veterans
    6. Physical health diagnostic contributors to suicide risk among veterans
    7. Military suicide protective factors
    8. Developmental trajectory of a suicide
  6. Assessment of Depression and Suicide
    1. What depressed Service Members look like
    2. Case study: assessing mood
    3. Self-report screens/measures of depressive symptoms
    4. Self-report measures of suicidal ideation/behavior
    5. Comprehensive assessment of risk
    6. VA/DoD Clinical Practice Guideline, considerations for risk assessment
  7. Fluid Vulnerability Theory
    1. Definition of acute risk
    2. Definition of chronic risk
    3. Multiple attempters and risk level
    4. Assessing risk, continued
    5. Case study: assessing suicide risk
    6. Risk continuum
  8. Treatments for Depression
    1. Course/phases of depression
    2. MDD psychotherapies: efficacious and specific therapies
  9. CBT for depression
    1. Cognitive model: example
    2. Expanded cognitive model
    3. Common cognitive distortions of military personnel
    4. Cognitive therapy
    5. Behavioral experiments
    6. General session structure
    7. Behavioral theory of depression
    8. Behavior therapy: Behavioral activation
    9. Behavioral therapy: Problem solving therapy
  10. Interpersonal therapy
  11. Therapies effective in the prevention of MDD relapse/recurrence
    1. Cognitive behavioral therapy and mindfulness-based CBT
  12. Treatments for Suicidal Ideation and Behavior
    1. Recommendations for follow-up & monitoring of at risk military patients
    2. Empirically supported treatments
    3. Dialectical Behavior Therapy (DBT)
    4. Means Restriction (public health approach)
    5. Cognitive Therapy for Suicide
  13. Cognitive Therapy for Suicide
  14. Results of cognitive therapy study
  15. Sessions 1, 2, and 3: early sessions
  16. Safety plan vs. Safety contract
  17. Safety plan
  18. Sessions 4, 5, 6, and 7: middle sessions
  19. Sessions 8, 9, and 10: later sessions
  1. Promising Treatments and Interventions for Suicidal Ideation and Behavior
  1. Collaborative Assessment and Management of Suicidality
  2. SAFE Vet
  3. Means Restriction Counseling

​Demonstrations, role-plays, videos, and case examples will be incorporated throughout the presentation.

Duration: 

150-240 minutes (10 minute break required every 90 minutes)

Notes:

One exercise may require participants to form pairs and walk around for 5 minutes so the room must be large enough for this activity.

*Continuing education credits are available for this course. Fees may apply.