Study Shows Most Veterans Support Integration of Standardized Suicide Risk Assessment into Routine Primary Care Visits
The U.S. suicide rate increased 30% between 2000 and 2020. Veterans are 1.5 times more likely to die by suicide compared to non-Veterans, with almost half of those who received healthcare in the six months prior to death making contact with their primary care team. Population-based (“universal”) suicide risk screening and evaluation processes are increasingly being implemented in primary care settings; it is therefore critical to understand patient attitudes towards routine screening, and to learn how to make the screening process more patient-centered. This study sought to characterize VA primary care patients’ perspectives regarding population-based suicide risk screening through the Risk ID program – a multi-stage suicide risk assessment process, which includes initial screening (the focus of this analysis) and subsequent evaluation when indicated (following a positive screen). Using VA data from all VA facilities (except one due to the EHR transition), investigators randomly selected Veterans to receive a survey. Of the 1,936 Veterans who received the survey, 868 (45%) returned it within the study window. The quantitative survey included three questions on attitudes about screening for suicidal thoughts in primary care. In qualitative interviews (n=30), Veterans were asked about their experiences with Risk ID processes, and recommendations for improving Risk ID.
- Most Veterans support integration of standardized suicide risk assessment into routine primary care visits. More than 90% of Veterans reported that it is appropriate for primary care providers or nurses/medical assistants to ask Veterans about suicidal thoughts during these visits. And approximately half indicated that Veterans should be asked about suicidal thoughts at every visit.
I know from my experience that this is something that I don’t talk to anybody about. I don’t talk to my wife about it. And you know don’t really talk to any friends about it. So, you know I think it is good that people have the opportunity to talk about this, you know something that they maybe wouldn’t tell anyone else. —Gulf war era Veteran
- Qualitative findings revealed that while most Veterans were generally supportive of VA screening for suicidal thoughts, they also expressed concern for the potential for inadvertent harm (i.e., repeated screening could turn into “white noise”). They also noted that question wording, body language, and care team role affected whether the process was a positive or negative experience.
- Additional guidance or training for staff conducting suicide risk screening may be warranted to ensure Veterans feel heard (e.g., eye contact, expressing empathy) and increase patient understanding of the purpose of the screening and potential outcomes.
This study was funded by HSR&D (IIR 19-215). Drs. Denneson, Newell, Niederhausen, Handley, Carlson, and Dobscha, and Ms. Elliott, Rynerson, and Salvi are part of HSR&D’s Center to Improve Veteran Involvement in Care (CIVIC) in Portland, OR.
Denneson L, Newell S, Elliott V, Rynerson A, Niederhausen M, Salvi A, Handley R, Bahraini N, Post E, Carlson K, and Dobscha S. Veteran Perspectives on Population-based Suicide Risk Screening in VHA Primary Care: Mixed Methods Study. Journal of General Internal Medicine. March 20, 2023; online ahead of print.