Videoconference-Based Brief Cognitive Behavioral Therapy for Patients With Mood Disorders at High Risk for Suicide

Number of Suicide Attempts Assessed Using the Columbia-Suicide Severity Rating Scale (C-SSRS)

The occurrence of suicide attempts will be assessed at baseline, post-treatment, and follow-up using the Columbia-Suicide Severity Rating Scale (C-SSRS), administered through in-person or telephone interviews. When available, reported suicide attempts will be cross-checked with relevant medical records.

Time to First Suicide Attempt Following Treatment Assessed Using the Columbia-Suicide Severity Rating Scale (C-SSRS)

Time to first suicide attempt will be defined as the number of days from treatment completion to the first subsequently reported suicide attempt. Suicide attempts will be assessed at the post-treatment and follow-up assessments using the Columbia-Suicide Severity Rating Scale (C-SSRS), administered in person or by telephone.

Baseline Differences in Serum Inflammatory Biomarker Levels Measured by Enzyme-Linked Immunosorbent Assay (ELISA)

Serum concentrations of IL-1β, IL-6, IL-8, IL-10, TNF-α, sTNF-αR1, CRP, CCL-2, CXCL-1, and IFN-γ will be measured using enzyme-linked immunosorbent assays (ELISA). Baseline inflammatory biomarker levels will be compared among patients with mood disorders at high risk for suicide, patients with mood disorders at low risk for suicide, and healthy controls.

Change in Serum Inflammatory Biomarker Levels Measured by Enzyme-Linked Immunosorbent Assay (ELISA)

Changes in serum concentrations of IL-1β, IL-6, IL-8, IL-10, TNF-α, sTNF-αR1, CRP, CCL-2, CXCL-1, and IFN-γ will be assessed among participants with mood disorders at high risk for suicide who are randomized to V-BCBT plus TAU or TAU alone. Biomarker changes will also be examined in relation to treatment effects on suicide-related outcomes. Participants in the low-suicide-risk and healthy control groups will undergo biomarker assessment at baseline only.

Severity of Suicidal Ideation Assessed With the Columbia-Suicide Severity Rating Scale (C-SSRS)

Suicidal ideation severity will be assessed using the C-SSRS severity scale, which ranges from 1 (wish to be dead) to 5 (active suicidal ideation with a specific plan and intent). Higher scores indicate greater severity of suicidal ideation.

Intensity of Suicidal Ideation Assessed With the Columbia-Suicide Severity Rating Scale (C-SSRS)

The intensity of suicidal ideation will be assessed using the C-SSRS Intensity of Ideation items, which evaluate frequency, duration, controllability, deterrents, and reasons for suicidal thoughts. The five item scores are summed to yield a total score ranging from 0 to 25, with higher scores indicating greater suicidal ideation intensity. The measure will be administered at baseline to all participants and longitudinally only to randomized high-suicide-risk participants.

Severity of Suicidal Ideation Assessed With the Beck Scale for Suicide Ideation (SSI)

Suicidal ideation will be assessed using the self-report Beck Scale for Suicide Ideation (SSI). Items assess the presence and severity of suicidal thoughts and related characteristics. The total score ranges from 0 to 38, with higher scores indicating greater suicidal ideation severity. The SSI will be administered at baseline to all participants and longitudinally only to randomized high-suicide-risk participants.

Depressive Symptoms Assessed With the Hamilton Depression Rating Scale (HAM-D)

Depressive symptom severity will be assessed using the clinician-rated Hamilton Depression Rating Scale (HAM-D). For the 17-item HAM-D, total scores range from 0 to 52, with higher scores indicating greater depressive symptom severity.

Death-Self Implicit Association Assessed With the Death Implicit Association Test (D-IAT)

Implicit associations between death and the self will be assessed using the computer-based Death Implicit Association Test (D-IAT). A D-score will be calculated from reaction times during death-self and life-self classification conditions. Positive values indicate a relatively stronger death-self association, whereas negative values indicate a relatively stronger life-self association.

Fearlessness About Death Assessed With the Acquired Capability for Suicide Scale-Fearlessness About Death (ACSS-FAD)

Fearlessness about death will be assessed using the 7-item Acquired Capability for Suicide Scale-Fearlessness About Death (ACSS-FAD). Items are rated from 0 to 4. Total scores range from 0 to 28, with higher scores reflecting greater fearlessness about death.

Interpersonal Needs Assessed With the Interpersonal Needs Questionnaire (INQ)

Perceived burdensomeness and thwarted belongingness will be assessed using the 15-item Interpersonal Needs Questionnaire (INQ). The INQ consists of 9 items assessing thwarted belongingness and 6 items assessing perceived burdensomeness. Each item is rated on a 7-point scale from 1 (not at all true for me) to 7 (very true for me). After reverse-scoring the appropriate items, items are summed to calculate the respective subscale scores, which range from 9 to 63 for thwarted belongingness and from 6 to 42 for perceived burdensomeness. Higher scores indicate greater thwarted belongingness and perceived burdensomeness.

Manic Symptoms Assessed With the Young Mania Rating Scale (YMRS)

Manic symptom severity will be assessed using the 11-item clinician-rated Young Mania Rating Scale (YMRS). Total scores range from 0 to 60, with higher scores indicating greater severity of manic symptoms.