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Abstract title: Suicidal Thoughts Among Elderly Primary Care Veterans: Results from a Multi-site Study (PRISMe)

Author(s):
MD Llorente - Miami VA Medical Center
EJ Olsen - Miami VA Medical Center
E Coakley - John Snow Research and Training Institute
SG Cooley - VA Central Office
WW Van Stone - VA Central Office
UN Durai - VA Chicago Health Care System, West Side Division
JE Kirchner - HSR&D Center for Mental Health and Outcomes Research
DW Oslin - Philadelphia VA Medical Center
DD Krahn - William S. Middleton Memorial Veterans Hospital

Objectives: To determine the prevalence of suicidal thoughts among older primary care veterans and to identify predictive factors to improve targeted screening.

Methods: Systematic mental health screenings of veterans aged 65+, in selected primary care settings at 6 VAMC’s, conducted as part of the Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISMe) project. Screening instruments and questions included the Prime-MD question on suicidality and self harm, demographics, health status, and social support networks.

Results: Preliminary analysis of the 9578 veterans screened revealed 69 (0.72%) patients who endorsed thoughts of suicide or self-harm. Demographics of the suicidal patients was: 41 (59.4%) White; 17 Black (24.6%), Hispanic 4(5.8%), all others 7 (10.14%). Hispanics were over-represented in the suicidal group ( 2.9% of total v. 5.8% of suicidal ) as were “all other” group (3.3% of total , but 10.1% of suicidal). 16% of the suicidal group rated their health as good/excellent. 75% of the suicidal group had GHQ scores above cutpoints and 46% screened positive for PTSD. ,compared to only 25% and 8.8% of the non-suicidal group, respectively. 34.7% of the suicidal group were receiving mental health treatment (one in substance abuse) compared to 5.2% of the non-suicidal group. 46% of the suicidal group was aged 75 and older, with 9 of these receiving mental health treatment. Of the aged 65-74 group, 62.5% were receiving mental health treatment.

Conclusions: : Thoughts of self-harm are prevalent among elderly primary care veterans, with Hispanics and Asian-Pacific Islanders, Native-American Indian, or native Alaskan over-represented. Suicidal patients were more likely to report their health as fair/poor and there was an association between higher GHQ scores and symptoms of PTSD. Older age veterans (75+) were less likely to be receiving mental health services.

Impact statement: Suicide is highly preventable but is often unrecognized in primary care. Screening for suicidality is particularly important in older adults who report poorer health and have comorbid PTSD or depression. Even those patients who are currently receiving mental health treatment may report these thoughts, so that all patients should be screened regularly.