Experiences of veterans and partners engaged in Treatment for Relationships & Safety Together (TR&ST): A multi-method examination of a couple-based suicide intervention

Objectives: Relationship distress is a significant predictor of suicide and Veterans are at increased risk for both suicide and relationship distress. Veteran couples experience increased exposure to traumatic events, deployment cycles, and more; however, there are limited treatment options targeting both relationship functioning and suicidal thoughts and behaviors. Treatment for Relationships & Safety Together (TR&ST), an 11-session couple-based suicide prevention, aims to address this gap in care. Methods: This paper describes the qualitative experiences and quantitative data from 12 veterans and their intimate partners ( N = 24 participants) in a clinical pilot trial with veterans screening Columbia-Suicide Severity Rating Scale (C-SSRS) > 2 in the past month (active suicidal ideation) or a suicide attempt in the past 3 months. Each couple completed baseline, mid, post, and 3-month follow-up assessments. Post-treatment assessment qualitative interviews were recorded, transcribed, and coded using the qualitative DelveTool software. Quantitative data were analyzed in SPSS. Results: In respect to outcomes, Veterans experienced reduction in suicidal thoughts consistent with a moderate effect size Cohen’s d (-.42). Couples reported small to moderate improvement in relationship satisfaction (.30 and .62). In qualitative interviews, couples reported using skills gained in treatment and shared the benefits and challenges of engaging in a couple-based suicide intervention together. Post-treatment qualitative data indicated: 1) more understanding/openness, 2) more support, and 3) improved communication patterns. Challenges to engaging in treatment and using skills outside of the session for both veterans and partners were fear of: 1) judgement, 2) causing more emotional pain, and 3) making suicidal thoughts worse. Conclusion: Preliminary results suggest that TR&ST is a promising treatment option for suicide prevention in Veterans.