Meaning in life drives reductions in suicide risk among acutely suicidal soldiers receiving a crisis response plan

Objective: The purpose was to examine temporal associations among meaning in life and suicide risk across suicide-focused interventions. Methods: A secondary analysis was conducted using data from a randomized clinical trial testing the efficacy of a standard crisis response plan (S-CRP) and a CRP enhanced with a discussion about the patient's reasons for living (E-CRP) as compared to treatment as usual (TAU). A total of 97 active duty U.S. Army personnel presenting to military emergency departments and outpatient behavioral health clinics with active suicide ideation or a lifetime history of suicide attempts were enrolled between January 2013 and February 2016. Meaning in life and suicide risk were assessed at baseline and 1, 3, and 6 month follow-ups. Results: The association of meaning in life with time-lagged suicide risk significantly differed across treatment groups (p = .024). In TAU, meaning in life was not significantly associated with later reductions in suicide risk. In S-CRP, a stronger desire to establish meaning in life was significantly associated with later reductions in suicide risk (p < .001). In E-CRP, a stronger sense of purpose and meaning in life was significantly associated with later reductions in suicide risk (p < .001). Discussion: Faster reductions in suicide risk observed among patients who receive a CRP are attributable in part by the effects of strengthened meaning in life. Different facets of meaning in life contribute to reduced suicide risk in unique ways across treatments with varying components. Clinical Trials Registration: Data used in this secondary analysis came from ClinicalTrials.gov identifier NCT02042131.