2019 HSR&D/QUERI National Conference

4029 — Methodologic and Practical Considerations for Assessing Suicidal Ideation: Guidance for Health Services Researchers

Lead/Presenter: Jennifer Funderburk,  VA Center for Integrated Healthcare
All Authors: Funderburk JS (VA Center for Integrated Healthcare), Shepardson RS (VA Center for Integrated Healthcare), Pigeon W (VA Center of Excellence for Suicide Prevention)

With the increased interest in identifying strategies to improve suicide prevention, assessment of suicidal ideation within health services research is becoming more common. Due to stigma, participant reluctance to disclose, and a need to provide appropriate follow-up, as well as increased IRB oversight, researchers need to know how to approach the assessment and management of suicidal ideation among research participants in an ethical and effective manner. This presentation will describe the methodological and practical considerations researchers need to consider when assessing suicidal ideation among outpatient research participants.

Across six years, we regularly utilized three common assessment measures both in person and over the telephone (Columbia Suicide Severity Index, Beck Scale for Suicidal Ideation, Patient Health Questionnaire-9 item #9) in our pilot (n = 222) and subsequent HSRD-funded grant (n = 464) examining a brief behavioral activation intervention for primary care Veterans with depressive symptoms. Over 25 research staff across three sites were involved, and a total of 30% (n = 209) of Veterans endorsed ideation at the initiation of the research process. We developed and refined processes for management of participants with suicidal ideation and training research staff.

During pilot work, our team observed: participants' misinterpretation of questions, limitations of current assessment measures to assess ideation thoroughly, and lack of honesty about the presence of suicidal ideation at baseline. We will share several practical strategies that we included in our HSRD-funded clinical trial to address these issues, including: training research staff to increase comfort and honesty, inclusion of several measures of ideation and risk factors important to risk management, and adding questions about when ideation began. Additional practical tips for researchers include appropriate adaptations to the informed consent, necessary procedures for managing participants at imminent risk, and developing partnerships with onsite clinical providers and Crisis hotline.

Researchers need to understand the limitations of suicide assessment measures as well as the minimum processes required to ensure ethical and effective risk assessment and management.

This presentation will equip HSRD researchers with sound strategies to assess and manage suicidality among research participants improving both the research process and clinical care provided to Veterans.