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Rates and Correlates of Positive Suicidal Ideation Screens among OEF/OIF Veterans with Positive Depression Screens

Corson K, Denneson LM, Helmer DA, Duckart JP, Bair MJ, Dobscha SK. Rates and Correlates of Positive Suicidal Ideation Screens among OEF/OIF Veterans with Positive Depression Screens. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 17; National Harbor, MD.


Objectives: Suicide among Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans is a national concern. As part of its overall suicide prevention strategy, VA began systematic screening for suicidal ideation (SI) in 2008. Little is known about the predictors and correlates of SI. The objective of this study was to identify rates of SI among OEF/OIF Veterans with positive Patient Health Questionnaire (PHQ) depression screens, and to examine relationships between PHQ scores, type of SI screen administered, patient demographics, and SI screen results. Methods: We matched DoD OEF/OIF Roster data with VA Decision Support System (DSS) data to identify OEF/OIF Veterans screened for depression (PHQ-2 or PHQ-9) in primary care or ambulatory mental health settings between April 2008 and September 2009 in three large, geographically-distinct VA Medical Centers. Using manual medical record review, we recorded PHQ-2 scores and type and results of SI screens conducted within one month of positive depression screens (PHQ-2 score > = 3/6). Logistic regression was used to test predictors of SI screen results. Results: Of 8,822 OEF/OIF Veterans screened for depression, 1,662 (19%) screened positive. Of these, 1,331 (80%) were screened for SI within 30 days of their depression screens using the PHQ-9th item or the VA Pocketcard Screen (VA-PC), and 426/1,331 (32%) had positive SI screens. In multivariate analyses, the likelihood of screening positive for SI increased with PHQ-2 score (reference: X = 3; X = 4: OR = 1.74,CI 1.18-2.58; X = 5: OR = 2.39,CI,1.51-3.79; X = 6: OR = 3.22,CI:2.19-4.74), being screened with the PHQ-9th item (vs. the VA-PC: OR = 5.31,CI:3.99-7.05), and age (25-34 vs. < 25, OR = 1.57, CI:1.15-2.15); Nagelkerke's R-square = .21. No other variable (gender, age > 35, ethnicity, marital status, education, urban/rural residence, military branch) was predictive. Implications: Approximately one-third of OEF/OIF Veterans with positive depression screens screened positive for SI. PHQ-2 score was positively associated with SI. Administration of the PHQ-9th item increased the odds of a positive SI result by 5-fold in contrast to the VA-PC screen, suggesting that wording or response option differences may play an important role in SI screen results. Impacts: Suicidal ideation is common among OEF/OIF Veterans receiving VA care. Screening tools should be further assessed among diverse patients to insure an appropriate balance of sensitivity and specificity.

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