Abstract
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. 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. 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. Standardized suicide risk screening and evaluation tools. 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. 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). 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.
Highlights
In 2016, the Joint Commission released a Sentinel Event Alert[1] that shifted how health care systems approach the detection of suicide risk
Compared with veterans screened in ambulatory care, those screened in the emergency department (ED) or urgent care clinic (UCC) were more likely to endorse suicidal ideation with intent, 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
Risk Identification Strategy (Risk ID) is a crucial step toward a unified strategy to improve the detection and management of suicide risk among all veterans presenting to the Veterans Health Administration (VHA) for care
Summary
In 2016, the Joint Commission released a Sentinel Event Alert[1] that shifted how health care systems approach the detection of suicide risk This alert highlighted that a significant number of individuals who died by suicide were not receiving mental health care. Recognizing the need to implement more upstream efforts that are consistent with the National Strategy for Preventing Veteran Suicide 2018-2028,6 the VHA Office of Mental Health and Suicide Prevention established an interdisciplinary workgroup of experts to identify an evidence-informed approach to detect suicide risk among patients across VHA settings. Individuals who screen positive at 1 level move on to the level of screening or evaluation
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