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Office of Research & Development |
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VA Research Currents archive
Posted August 30, 2013
(Fall 2013 VA Research Currents; online ahead of print)
When a VA team interviewed 34 Iraq and Afghanistan Veterans about their experiences with suicide risk assessment in the military and at VA medical centers, the researchers got an earful.
VA researchers conducted in-depth interviews with 34 Veterans to learn about their experiences with—and perceptions of—suicide risk assessments in VA and the military. (Photo: iStock)
Some of the Veterans talked about the hassle of being asked the same types of questions repeatedly throughout the day by different clinical staff.
Some said they resented being asked personal questions by staff they didn't know, with whom they had no ongoing relationship. Others disliked how the clinician failed to make eye contact while conducting the assessment, and seemed more interested in checking off a box on the computer screen.
Regarding the process in the military, some respondents told of routinely denying suicidal thoughts—even when they felt suicidal—so as to not risk unwanted hospitalization, or other delays in returning home after their deployment.
These were just some of the themes—positive and negative—that emerged from the in-depth, open-ended interviews. The full results, and an analysis, are available online in the Journal of General Internal Medicine and will be presented in November at the annual meetings of the Academy of Psychosomatic Medicine and the American Public Health Association.
The goal was to learn specifically about Veterans' experiences with brief structured assessments for suicidal thinking, which are administered routinely in VA primary care settings to those with indicators of depression or posttraumatic stress disorder. Suicide warning signs that surface during the initial assessment trigger more extensive clinical evaluation, with referrals to mental health care as appropriate.
"We wanted to explore these Veterans' perceptions of this process," says lead author Linda Ganzini, MD, MPH, of the Portland VA Medical Center and Oregon Health and Science University. "We wanted to learn about the factors that lead Veterans to disclose or not disclose suicidal thoughts, and what their perceptions are about the consequences of doing so."
The study was part of a larger VA-funded project headed by Steven Dobscha, MD, titled "Outcomes and Correlates of Suicidal Ideation in OEF/OIF Veterans." The research was based at the Portland, Indianapolis, and Houston VA medical centers.
VA adopted the assessment process to help stem the tide of Veteran suicides—22 per day, on average, according to a 2012 VA report. The report indicated that while the percentage of Veterans who die by suicide has gone down slightly since 1999, the estimated total number of Veteran suicide deaths per year has increased.
By all accounts, VA has taken some effective steps to help counter the trend—setting up a national crisis hotline, for example, hiring more mental health staff, and training all hospital staff to recognize suicide warning signs. VA also instituted the routine assessments of suicide risk for patients with depression or PTSD.
Dobscha and Ganzini's study is important because some research has suggested that routine risk assessments do not always do a good job of preventing suicide. For example:
The Veterans interviewed for Ganzini's study all had positive risk assessments for suicidal thinking in VA primary care clinics during 2009 or 2010. Some admitted to not having disclosed their suicidal thoughts during earlier assessments.
Based on the interviews, the researchers identified four themes they believe hold the key to improving assessment for suicide risk. Here are some of their recommendations in each area:
Ganzini says the study questions the effectiveness of suicide risk assessments that are implemented "in the context of routine medical screening or by triage personnel."
The main take-home message, she says, is that "candid discussion of suicidal thoughts is enhanced when the assessment is done by trusted providers who communicate genuine concern."
To read the full paper, including numerous anonymous comments from Veterans interviewed for the study, visit http://bit.ly/144OqBP.