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Key points
– The MSPIRE randomized clinical trial (NCT03769259) enrolled 108 US military personnel and veterans with recent suicidal ideation and/or behavior and compared brief cognitive behavioral therapy (BCBT) with present‑centered therapy (PCT).
– Over follow‑up, suicide attempts occurred in 2 participants (estimated 5.6%) assigned to BCBT versus 8 participants (estimated 27.9%) assigned to PCT; BCBT yielded a hazard ratio of 0.25 (90% CI, 0.07–0.90; P = .04).
– Suicidal ideation declined significantly in both arms with no between‑group difference, suggesting BCBT reduced transition from ideation to attempt beyond effects on ideation alone.