Engagement and outcomes of veterans endorsing suicidal ideation in a couple‐based treatment for posttraumatic stress disorder

Approximately half of veterans with posttraumatic stress disorder (PTSD) experience suicidal ideation (SI), and many report intimate relationship problems. Historically, there has been hesitation to engage veterans with SI in PTSD treatment for fear that trauma‐focused interventions could potentially exacerbate SI. Additional concerns include that veterans with SI would not be fully psychologically present, engaged in, and benefiting from treatment. This secondary analysis of data from a clinical trial of brief cognitive‐behavioral conjoint therapy for PTSD (bCBCT) examines engagement, retention, and PTSD and relationship satisfaction outcomes for 92 veterans and their intimate partners. Veterans were grouped by baseline report of SI in the past year ( n = 35) versus no SI ( n = 57). Treatment dropout did not significantly differ between veterans who reported SI and those who did not, χ 2 (1, N = 92) = 0.50, p = .479. Significant reductions in PTSD during treatment were observed for both veterans with, d = ‐1.34) and without SI, d = ‐0.87. Partners also reported reductions in veterans’ PTSD symptoms for veterans with SI, d = ‐0.46, and without SI, d = ‐0.82. PTSD symptom reduction did not differ significantly by SI status according to veteran or partner report. In contrast, we found no evidence of systematic change in relationship satisfaction for veterans or partners regardless of baseline SI status. There were no suicide‐related adverse events. The findings suggest that couples in which the veteran endorses SI can engage in and benefit from couple‐based PTSD treatment.