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Screening for Suicidal Ideation in VA Ambulatory Settings

Dobscha SK, Corson K, Helmer D, Bair M, Denneson LM, Ganzini LK. Screening for Suicidal Ideation in VA Ambulatory Settings. Paper presented at: Academy of Psychosomatic Medicine Annual Meeting; 2011 Nov 19; Phoenix, AZ.


Background: Suicide is devastating to families and communities. Approximately 6,000 Veterans complete suicide each year. Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans often have multiple risk factors for suicide. As part of its overall suicide prevention strategy, in 2008 the Veterans Affairs (VA) healthcare system began systematic screening for suicidal ideation (SI). While much research has been done to understand completed suicide and suicide attempts, relatively less is known about SI. Objective: To identify rates of positive depression and SI screens among OEF/OIF veterans treated in VA ambulatory care settings, and to examine correlates of positive SI screens among those screened in primary care and mental health settings. Methods: We used VA administrative databases to identify 8,912 OEF/OIF veterans who were screened for depression in ambulatory settings of three large, urban VA Medical Centers in different geographic regions between April 2008 and September 2009. Depression screening was conducted using the Patient Health Questionnaire (PHQ)-2 or the PHQ-9. SI screening tools, specific screening processes, and SI screen-scoring algorithms varied across the three sites. Manual medical record review was used to obtain or confirm screening dates and screen results. Chi-square and t-tests were used to compare groups in site-stratified analyses. Results: Of the 8,912 OEF/OIF veterans screened for depression, rates of positive depression screens ranged from 15% to 25% across the three sites. Of the 1,662 veterans screened in primary care or ambulatory mental health settings who had positive depression screens, 75% to 85% were subsequently screened for SI within 30 days of positive depression screens. Within this group, the prevalence of positive SI screens ranged from 33% to 38%. At one site, veterans with positive SI screens were more likely to have been screened for depression in mental health, as compared to primary care settings (35% vs. 22%; 2 = 11.8, p = .001). At another site, nonwhites were more likely than whites to screen positive for SI ( 2 = 9.8. p = .02) and veterans between the ages of 25 and 34 were more likely to screen positive for SI than patients younger than 25 or older than 34 ( 2 = 13.6 and p = 001). Otherwise, we detected no significant differences by location of screening, sex, or newness to VA care when comparing veterans with positive SI screens to veterans with negative SI screens. Conclusions: Suicidal ideation is common among OEF/OIF veterans with depressive symptoms who receive care in VA ambulatory settings. We did not detect demographic differences to distinguish veterans who endorse SI during clinic screening from those who do not endorse SI.

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