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IIR 21-218 – HSR Study

IIR 21-218
Serving All Who Have Served: Enhancing Suicide-Related Care Quality for Black, Indigenous, and People of Color Veterans
Jason I. Chen, PhD
VA Portland Health Care System, Portland, OR
Portland, OR
Funding Period: May 2023 - April 2027


Background: Veteran suicide prevention remains the top clinical priority for the Veterans Health Administration (VHA). To mitigate Veteran suicide risk, VHA has national guidelines recommending an enhanced care package after self-directed violence (SDV) such as creating a suicide safety plan or increasing the frequency of outpatient mental health visits. Adherence to each given care component is considered a marker of care quality for suicide risk (henceforth referred to as suicide-related care quality). Recent research utilizing national VHA data suggests these care components may not be provided equitably to all Veterans. As research shows that Black, Indigenous, and People of Color (BIPOC) Veterans experience poorer mental health care quality than white Veterans, it is possible that similar issues may impact their suicide-related care quality. However, no research to date has examined the quality of suicide-related care among BIPOC Veterans. Thus, further evaluation of suicide-related care quality is needed to ensure equitable, effective care for BIPOC Veterans with SDV. The current proposal seeks to evaluate components of suicide-related care quality among BIPOC Veterans using a concurrent, mixed-methods triangulation approach to inform future intervention development. Significance: The proposed project directly addresses VHA’s top clinical priority, suicide prevention. In addition, this proposal aligns with VA HSR&D’s high priority foci of suicide prevention and health equity as well as VHA National Strategic Plan Objectives 2.1 and 2.3 which focus on ensuring Veterans receive equitable, comprehensive suicide prevention services to support their recovery. VHA Office of Health Equity and VHA Office of Mental Health and Suicide Prevention also highlight in their strategic plans the need for supporting equitable, suicide-related care for all Veterans. Innovation and Impact: The proposed project is the first evaluation of suicide-related care quality among BIPOC Veterans with SDV. In addition, no research to date has determined areas to improve suicide-related care quality for BIPOC Veterans. Use of national VHA- and non-VHA administrative data triangulated with BIPOC Veteran and mental health clinician qualitative data will result in a richer conceptualization of current factors impacting suicide-related care and inform future strategies for enhancing care. Specific Aims: Aim 1) Evaluate suicide-related care quality among BIPOC Veterans; Aim 2) Conduct qualitative interviews with BIPOC Veterans and VA clinicians to better understand factors impacting suicide-related care quality for BIPOC Veterans; Aim 3) Explore associations between health care systems-level factors and suicide- related care quality indicators for BIPOC Veterans; Exploratory Aim) Explore the relationship between suicide- related care quality among BIPOC Veterans and suicide outcomes. Methodology: Aim 1 will identify BIPOC Veterans with SDV (FY18-FY22) utilizing VHA databases. Data from the VHA Corporate Data Warehouse for suicide-related care quality outcomes as well as sociodemographic and clinical variables will be linked. Data will be analyzed using generalized estimating equations. Aim 2 will involve interviews with at least 40 BIPOC Veterans and at least 40 VHA mental health clinicians about their beliefs and experiences with suicide-related care which will be analyzed using thematic analysis. Aim 3 will link data from Aim 1 to health care systems factors at the station level. For the Exploratory Aim will link data from mortality data sources to explore associations with mortality outcomes. Next Steps/ Implementation: The proposed project will increase our understanding of factors impacting suicide- related care quality among BIPOC Veterans. Findings from this project will inform future proposals focused on intervention development to enhance suicide-related care quality among BIPOC Veterans.

External Links for this Project

NIH Reporter

Grant Number: I01HX003545-01A2

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Journal Articles

  1. Laliberte AZ, Salvi A, Hooker E, Roth B, Handley R, Carlson K, Hynes D, Tuepker A, Chen JI. Factors associated with a lack of health care utilization among Veterans after a positive suicide screen in the emergency department. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2023 Apr 1; 30(4):321-330. [view]
  2. Weaver FM, Niederhausen M, Hickok A, O'Neill AC, Gordon HS, Edwards ST, Govier DJ, Chen JI, Young R, Whooley M, Hynes DM. Hospital Readmissions Among Veterans Within 90 Days of Discharge Following Initial Hospitalization for COVID-19. Preventing chronic disease. 2022 Dec 1; 19:E80. [view]
  3. Ward MJ, Hwang U, Hastings SN, Timko C, Chen JI, Vashi AA, Mattocks K, Abel EA, Bravata DM. Research and policy recommendations from the SOTA XVI: State of the Art Conference on VA Emergency Medicine. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2023 Apr 1; 30(4):240-251. [view]
  4. Denneson LM, Cameron DC, Hooker ER, Laliberte AZ, Chen JI. Self-Directed Violence Surveillance in the Veterans Health Administration: A National Examination of Factors Associated with Undetermined Versus Suicide Attempt Classification. Community mental health journal. 2023 Jul 1; 59(5):954-961. [view]
  5. Peterson A, Chen J, Bozzay M, Bender A, Chu C. Suicide risk profiles among service members and veterans exposed to suicide. Journal of Clinical Psychology. 2024 Jan 1; 80(1):65-85. [view]
  6. Denneson LM, Bollinger MJ, Meunier CC, Chen JI, Hudson TJ, Sparks CS, Carlson KF. Veteran suicide and associated community characteristics in Oregon. Preventive medicine. 2023 May 1; 170:107487. [view]

DRA: Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Observational, Prevention, TRL - Applied/Translational
Keywords: Quality of Care, Suicide, Utilization
MeSH Terms: None at this time.

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