Evaluating Evidence-Based Psychotherapy Utilization Patterns Among Suicide-Risk-Stratified Veterans Diagnosed with Major Depressive Disorder

Abstract

Major depressive disorder (MDD) is a leading risk factor for death by suicide. To better treat MDD, and reduce suicide risk, the US Department of Veterans Affairs, prioritizes a range of psychotherapeutic treatments, including MDD specific evidence-based psychotherapies (EBPs). To better understand the utilization of these interventions, and these interventions’ roles in suicide prevention, this study investigates a national sample of MDD-diagnosed VA patients who died and did not die by suicide in 2017 and 2018. The study used a dataset of VA patients diagnosed with MDD who died by suicide and received psychotherapy in the year before death (cases) and patients who had comparable diagnoses, demographics, and received psychotherapy during the same interval and remained alive (controls). Each case was matched with 10 controls who shared the same VA’s suicide risk algorithm risk score. The study tracked non-differentiated psychotherapy and MDD EBP, analyzed cases and controls’ utilization rates across risk-tiers (high, moderate, low), and conceptualized eight sessions as the minimum adequate treatment. Our final sample included high-risk (cases = 257; controls = 2570), moderate-risk (cases = 428 cases; controls = 4280), and low-risk (cases = 53; controls = 529) patients. No groups received adequate session count. MDD EBP utilization was markedly low, especially among cases, with < 1% of the high-risk sample receiving adequate sessions. Higher proportions of moderate- and low-risk controls received MDD EBP and received more sessions than matched cases. Even with VA efforts to promote EBPs, within our sample, MDD EBP usage was limited, particularly among patients who died by suicide. Further research is needed to understand utilization barriers and improve MDD EBP delivery to better support suicide prevention.