Cargando…
Assessment of Rates of Suicide Risk Screening and Prevalence of Positive Screening Results Among US Veterans After Implementation of the Veterans Affairs Suicide Risk Identification Strategy
IMPORTANCE: In 2018, the Veterans Health Administration (VHA) implemented the Veterans Affairs (VA) Suicide Risk Identification Strategy to improve the identification and management of suicide risk among veterans receiving VHA care. OBJECTIVES: To examine the prevalence of positive suicide screening...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578771/ https://www.ncbi.nlm.nih.gov/pubmed/33084900 http://dx.doi.org/10.1001/jamanetworkopen.2020.22531 |
_version_ | 1783598438015827968 |
---|---|
author | Bahraini, Nazanin Brenner, Lisa A. Barry, Catherine Hostetter, Trisha Keusch, Janelle Post, Edward P. Kessler, Chad Smith, Cliff Matarazzo, Bridget B. |
author_facet | Bahraini, Nazanin Brenner, Lisa A. Barry, Catherine Hostetter, Trisha Keusch, Janelle Post, Edward P. Kessler, Chad Smith, Cliff Matarazzo, Bridget B. |
author_sort | Bahraini, Nazanin |
collection | PubMed |
description | IMPORTANCE: In 2018, the Veterans Health Administration (VHA) implemented the Veterans Affairs (VA) Suicide Risk Identification Strategy to improve the identification and management of suicide risk among veterans receiving VHA care. OBJECTIVES: To examine the prevalence of positive suicide screening results among veterans in ambulatory care and emergency departments (EDs) or urgent care clinics (UCCs) and to compare acuity of suicide risk among patients screened in these settings. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the VA’s Corporate Data Warehouse (CDW) to assess veterans with at least 1 ambulatory care visit (n = 4 101 685) or ED or UCC visit (n = 1 044 056) at 140 VHA medical centers from October 1, 2018, through September 30, 2019. EXPOSURES: Standardized suicide risk screening and evaluation tools. MAIN OUTCOMES AND MEASURES: One-year rate of suicide risk screening and evaluation, prevalence of positive primary and secondary suicide risk screening results, and levels of acute and chronic risk based on the VHA’s Comprehensive Suicide Risk Evaluation. RESULTS: A total of 4 101 685 veterans in ambulatory care settings (mean [SD] age, 62.3 [16.4] years; 3 771 379 [91.9%] male; 2 996 974 [73.1%] White) and 1 044 056 veterans in ED or UCC settings (mean [SD] age, 59.2 [16.2] years; 932 319 [89.3%] male; 688 559 [66.0%] White) received the primary suicide screening. The prevalence of positive suicide screening results was 3.5% for primary screening and 0.4% for secondary screening in ambulatory care and 3.6% for primary screening and 2.1% in secondary screening for ED and UCC settings. Compared with veterans screened in ambulatory care, those screened in the ED or UCC were more likely to endorse suicidal ideation with intent (odds ratio [OR], 4.55; 95% CI, 4.37-4.74; P < .001), specific plan (OR, 3.16; 95% CI, 3.04-3.29; P < .001), and recent suicidal behavior (OR, 1.95; 95% CI, 1.87-2.03; P < .001) during secondary screening. Among the patients who received a Comprehensive Suicide Risk Evaluation, those in ED or UCC settings were more likely than those in ambulatory care settings to be at high acute risk (34.1% vs 8.5%; P < .001). CONCLUSIONS AND RELEVANCE: In this cross-sectional study, population-based suicide risk screening and evaluation in VHA ambulatory care and ED or UCC settings may help identify risk among patients who may not be receiving mental health treatment. Higher acuity of risk among veterans in ED or UCC settings compared with those in ambulatory care settings highlights the importance of scaling up implementation of brief evidence-based interventions in the ED or UCC to reduce suicidal behavior. |
format | Online Article Text |
id | pubmed-7578771 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-75787712020-10-27 Assessment of Rates of Suicide Risk Screening and Prevalence of Positive Screening Results Among US Veterans After Implementation of the Veterans Affairs Suicide Risk Identification Strategy Bahraini, Nazanin Brenner, Lisa A. Barry, Catherine Hostetter, Trisha Keusch, Janelle Post, Edward P. Kessler, Chad Smith, Cliff Matarazzo, Bridget B. JAMA Netw Open Original Investigation IMPORTANCE: In 2018, the Veterans Health Administration (VHA) implemented the Veterans Affairs (VA) Suicide Risk Identification Strategy to improve the identification and management of suicide risk among veterans receiving VHA care. OBJECTIVES: To examine the prevalence of positive suicide screening results among veterans in ambulatory care and emergency departments (EDs) or urgent care clinics (UCCs) and to compare acuity of suicide risk among patients screened in these settings. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the VA’s Corporate Data Warehouse (CDW) to assess veterans with at least 1 ambulatory care visit (n = 4 101 685) or ED or UCC visit (n = 1 044 056) at 140 VHA medical centers from October 1, 2018, through September 30, 2019. EXPOSURES: Standardized suicide risk screening and evaluation tools. MAIN OUTCOMES AND MEASURES: One-year rate of suicide risk screening and evaluation, prevalence of positive primary and secondary suicide risk screening results, and levels of acute and chronic risk based on the VHA’s Comprehensive Suicide Risk Evaluation. RESULTS: A total of 4 101 685 veterans in ambulatory care settings (mean [SD] age, 62.3 [16.4] years; 3 771 379 [91.9%] male; 2 996 974 [73.1%] White) and 1 044 056 veterans in ED or UCC settings (mean [SD] age, 59.2 [16.2] years; 932 319 [89.3%] male; 688 559 [66.0%] White) received the primary suicide screening. The prevalence of positive suicide screening results was 3.5% for primary screening and 0.4% for secondary screening in ambulatory care and 3.6% for primary screening and 2.1% in secondary screening for ED and UCC settings. Compared with veterans screened in ambulatory care, those screened in the ED or UCC were more likely to endorse suicidal ideation with intent (odds ratio [OR], 4.55; 95% CI, 4.37-4.74; P < .001), specific plan (OR, 3.16; 95% CI, 3.04-3.29; P < .001), and recent suicidal behavior (OR, 1.95; 95% CI, 1.87-2.03; P < .001) during secondary screening. Among the patients who received a Comprehensive Suicide Risk Evaluation, those in ED or UCC settings were more likely than those in ambulatory care settings to be at high acute risk (34.1% vs 8.5%; P < .001). CONCLUSIONS AND RELEVANCE: In this cross-sectional study, population-based suicide risk screening and evaluation in VHA ambulatory care and ED or UCC settings may help identify risk among patients who may not be receiving mental health treatment. Higher acuity of risk among veterans in ED or UCC settings compared with those in ambulatory care settings highlights the importance of scaling up implementation of brief evidence-based interventions in the ED or UCC to reduce suicidal behavior. American Medical Association 2020-10-21 /pmc/articles/PMC7578771/ /pubmed/33084900 http://dx.doi.org/10.1001/jamanetworkopen.2020.22531 Text en Copyright 2020 Bahraini N et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Bahraini, Nazanin Brenner, Lisa A. Barry, Catherine Hostetter, Trisha Keusch, Janelle Post, Edward P. Kessler, Chad Smith, Cliff Matarazzo, Bridget B. Assessment of Rates of Suicide Risk Screening and Prevalence of Positive Screening Results Among US Veterans After Implementation of the Veterans Affairs Suicide Risk Identification Strategy |
title | Assessment of Rates of Suicide Risk Screening and Prevalence of Positive Screening Results Among US Veterans After Implementation of the Veterans Affairs Suicide Risk Identification Strategy |
title_full | Assessment of Rates of Suicide Risk Screening and Prevalence of Positive Screening Results Among US Veterans After Implementation of the Veterans Affairs Suicide Risk Identification Strategy |
title_fullStr | Assessment of Rates of Suicide Risk Screening and Prevalence of Positive Screening Results Among US Veterans After Implementation of the Veterans Affairs Suicide Risk Identification Strategy |
title_full_unstemmed | Assessment of Rates of Suicide Risk Screening and Prevalence of Positive Screening Results Among US Veterans After Implementation of the Veterans Affairs Suicide Risk Identification Strategy |
title_short | Assessment of Rates of Suicide Risk Screening and Prevalence of Positive Screening Results Among US Veterans After Implementation of the Veterans Affairs Suicide Risk Identification Strategy |
title_sort | assessment of rates of suicide risk screening and prevalence of positive screening results among us veterans after implementation of the veterans affairs suicide risk identification strategy |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578771/ https://www.ncbi.nlm.nih.gov/pubmed/33084900 http://dx.doi.org/10.1001/jamanetworkopen.2020.22531 |
work_keys_str_mv | AT bahraininazanin assessmentofratesofsuicideriskscreeningandprevalenceofpositivescreeningresultsamongusveteransafterimplementationoftheveteransaffairssuicideriskidentificationstrategy AT brennerlisaa assessmentofratesofsuicideriskscreeningandprevalenceofpositivescreeningresultsamongusveteransafterimplementationoftheveteransaffairssuicideriskidentificationstrategy AT barrycatherine assessmentofratesofsuicideriskscreeningandprevalenceofpositivescreeningresultsamongusveteransafterimplementationoftheveteransaffairssuicideriskidentificationstrategy AT hostettertrisha assessmentofratesofsuicideriskscreeningandprevalenceofpositivescreeningresultsamongusveteransafterimplementationoftheveteransaffairssuicideriskidentificationstrategy AT keuschjanelle assessmentofratesofsuicideriskscreeningandprevalenceofpositivescreeningresultsamongusveteransafterimplementationoftheveteransaffairssuicideriskidentificationstrategy AT postedwardp assessmentofratesofsuicideriskscreeningandprevalenceofpositivescreeningresultsamongusveteransafterimplementationoftheveteransaffairssuicideriskidentificationstrategy AT kesslerchad assessmentofratesofsuicideriskscreeningandprevalenceofpositivescreeningresultsamongusveteransafterimplementationoftheveteransaffairssuicideriskidentificationstrategy AT smithcliff assessmentofratesofsuicideriskscreeningandprevalenceofpositivescreeningresultsamongusveteransafterimplementationoftheveteransaffairssuicideriskidentificationstrategy AT matarazzobridgetb assessmentofratesofsuicideriskscreeningandprevalenceofpositivescreeningresultsamongusveteransafterimplementationoftheveteransaffairssuicideriskidentificationstrategy |