September 2023

In This Issue: HSR&D Research on Suicide Prevention

Understanding the Impact of VA’s New Suicidal Ideation Screening Initiative: The Veterans’ Perspective

Feature Article

Takeaway: Population-based screening for suicidal ideation (SI) is becoming standard practice, but Veterans sometimes feel uncomfortable disclosing SI during screening, and negative perceptions of SI screening can adversely affect Veterans’ subsequent engagement in care. To fill the sizable gap in what is known about SI screening’s effects on subsequent treatment engagement, this study is examining the impacts of population-based SI screening—including what Veterans think about it.

Population-based screening for suicidal ideation (SI) is becoming standard practice; recently, VA introduced “VA Risk ID,” a new multi-stage SI screening and evaluation process. However, prior research has shown that Veterans often feel uncomfortable disclosing SI during screening, and they frequently do not disclose SI at healthcare visits when a suicide attempt is imminent. Negative perceptions of SI screening can adversely affect Veterans’ comfort with disclosing and discussing SI, as well as subsequent engagement in care.

This ongoing study (December 2019–November 2023) seeks to generate information about the impacts of population-based SI screening, Veterans’ perspectives of SI screening, and the relationship between screening experiences and subsequent engagement in care. Researchers aim to:

• Conduct quantitative surveys of a national random sample of Veterans screened in primary care, mental health, and emergency departments to characterize Veterans’ experiences with VA Risk ID and the clinical evaluation that occurs in response to screening.
• Conduct qualitative interviews with Veterans and staff members who participate in SI screening, with the goal of identifying ways to improve screening and engagement after screening.
• Among the group of Veterans screened in primary care and emergency departments, examine the extent to which screening process variables are associated with the use of mental health treatment over six months.

Methods

Researchers will mail recruitment letters immediately after VA Risk ID screening to 2,000 Veterans screened in primary care, 2,000 Veterans screened in specialty mental health, and 2,000 Veterans screened in emergency departments who did not receive mental health treatment during the prior 12 months. Surveys will assess satisfaction with screening, patient-care team interactions, and perceived barriers to care and disclosure. Informed by survey results, up to 60 Veterans from the survey cohorts and up to 40 clinical staff members from primary care, emergency departments, and mental health settings of three or more VA facilities will participate in semi-structured interviews. Qualitative analyses will seek to identify ways for clinical teams to detect and respond to SI more satisfactorily and effectively. Within the group of Veterans screened in primary care and emergency departments, researchers will examine the extent to which screening results and survey variables are associated with subsequent engagement in mental health treatment over six months. Outcomes will include specialty mental health visits attended (when referred) and antidepressant fills (when recommended by providers). Researchers will adjust for patient, care team, and site characteristics.

Findings are not yet available.

Anticipated Impact

This project will characterize the treatment of Veterans screened for SI in primary care, emergency departments, and mental health settings primarily from the perspective of Veterans. Findings will inform further development and implementation of VA’s SI screening, and lay groundwork for development and testing of new interventions to improve SI screening and care engagement, as well as additional research on the impacts of early care experiences of Veterans at risk for suicide.

Principal Investigator

Steven Dobscha, MD, is director of HSR&D’s Center to Improve Veteran Involvement in Care in Portland, OR.

Recent related publications by this investigator

Dobscha SK, Newell SB, Elliott VJ, et al. Primary care and mental health staff perspectives on universal suicide risk screening and care coordination. Psychiatric Services. March 1, 2023;74(3):305–311.

Newell S, Denneson L, Dobscha SK, et al. Veterans Health Administration staff experiences with suicidal ideation screening and risk assessment in the context of COVID-19. PLOS ONE. December 28, 2021;16(12):e0261921.

View the study abstract.