Lead/Presenter: Steve Zeliadt, COIN - Seattle/Denver
All Authors: Zeliadt S (Seattle HSRD), Upchurch D (UCLA, Department of Community Health) Resnick A (Los Angeles HSR&D) Taylor SL (Los Angeles HSR&D)
Objectives:
As part of the VA’s Whole Health transformation, providing and studying complementary and integrative health (CIH) therapies is a VA priority, and eight CIH therapies are medical care in the VA. Veterans have reported to feel reduced pain, anxiety and/or depression after using some CIH therapies, with many reporting that relief has given them hope for an improved life in the future. As such, CIH therapies might help Veterans’ risk of suicide. Accordingly, we investigated the relationship between CIH therapy use and subsequent suicide risk (SR) among Veterans.
Methods:
Using data from the VA Complementary and Integrative Health Evaluation Center (PI: Taylor) Data Nexus (PI: Zeliadt) project database, we examined Veterans’ use in FY19 of a combination of ten CIH therapies on SR. The ten CIH therapies were chiropractic care, traditional acupuncture, battlefield acupuncture, therapeutic massage, yoga, Tai Chi/Qigong, meditation/mindfulness, guided imagery, biofeedback, and hypnosis. We created categories for the number of visits (0, 1-2, 3-5, 6-10, 11+). Data for the SR outcome came from the VA’s Programs and Evaluation Resource Center database. We first used the Suicide Risk Identification Strategy to define our outcome. This Strategy is a 3-stage SR screening: 1) Patient Health Questionnaire; 2) Columbia Suicide Severity Rating Scale; and 3) VHA’s Comprehensive Suicide Risk Evaluation (CSRE). We included Veterans with no CSRE in FY19 as our baseline population (i.e., had no SR) and assessed their subsequent FY20 CSRE scores. We then operationalized the CSRE three ways: 1) acute SR (none, low, medium, high); 2) chronic SR (none, low, medium, high); and 3) combined SR (none, low-low, low-med, low-high, med-med, high-high). We used ordered multinomial logit models controlling for gender, age, race and ethnicity, number of chronic conditions, mental health diagnosis, and diagnosis of chronic pain.
Results:
Of the 5,127,529 Veterans using the VHA at baseline FY19 (i.e., no SR in FY19), 139,891 (2.7%) had a CSRE score in FY20. Overall, across the three operationalizations of SR, those with low CIH therapy use (1-2 visits) had a significantly higher SR relative to non-CIH users, but high frequency CIH users (6-10 visits and 11+ visits) had a significantly lower SR. The results were consistent across the three SR outcomes for the group of CIH users having 11+ visits. However, for some outcomes, the effects of having 11+ CIH therapy visits increased with the increasing severity of SR score. For example, for acute SR, low SR (RR = .905 p < .001), and high SR the (RR = .664 p < .001). Veterans with chronic pain or mental health diagnoses had significantly higher SR relative those who did not across all 3 SR measures. Also, SR decreased with age and Blacks relative to whites had higher SR.
Implications:
Veterans who used CIH therapies had lower subsequent SR relative to non-CIH users (except for infrequent users). The effects of CIH therapies on SR were relatively consistent across the three SR measures.
Impacts:
CIH therapies should be made more readily available as another possible tool in the Veteran suicide risk prevention toolbox.