1040 — Implementation Research and Suicide Risk: Qualitative Analysis of an Assessment Process for Suicide Risk in a Sample of Depressed Veterans

Campbell D (Seattle Center of Excellence (COE)), Bonner LM (Seattle COE), Bolkan CR (Seattle COE), Chaney EF (Seattle COE), Rubenstein LV (Sepulveda COE), Sherman S (VA New York Harbor HCS), Felker B (VA Puget Sound HCS)

Objectives:
Effective implementation research on chronic illness best practices necessitates successful detection and management of suicidal ideation (SI) and risk. Currently, little guidance exists regarding effective suicide prevention protocols for studies using telephone surveys. We assessed the impact and results of researcher management of SI in TIDES/WAVES, studies where depressed veterans from 10 VA primary care clinics in 3 VISNs completed telephone surveys.

Methods:
Trained non-clinical study staff telephone-screened 10,929 veterans with upcoming primary care visits for depression using the PHQ-9; 761 veterans with probable major depression were enrolled. We implemented a three-phase suicide prevention process. Phase one assessed and tested each site’s suicide policy, linking it to a TIDES/WAVES suicide prevention template. Phase two included initial risk assessment triggered by interviewer detection of SI (defined by protocol). Phase three followed positive risk assessment; an on-call doctoral-level research clinician immediately contacted the at-risk patient. We documented and assessed each phase through study documents, interviewers’ logs, and qualitative analysis of de-identified clinician contact notes.

Results:
Although no study sites had fully functional threatened suicide policies at baseline, all successfully updated or modified their policies and linked to TIDES/WAVES research protocols. 299 patients required phase two suicide risk assessment by non-clinical interviewers. 50 patients (17%) required contact with research clinicians (average=20 minutes). 14 of these (28%) required immediate consultation with local VA or non-VA crisis personnel or Emergency Medical Services. Remaining patients received telephone counseling by study clinicians and/or urgent referral to local VA clinicians. Qualitative clinician note analysis yielded two meta-themes: (a) in-depth risk assessment activities (e.g., identification of mental health issues, substance abuse, social isolation, stressors), and (b) risk reduction activities (e.g., discussion/implementation of no-harm contracts, referral to local care). To our knowledge, no patient completed suicide during our window of responsibility.

Implications:
Interviewers frequently encounter SI in depression studies. Whereas our three-phase protocol required substantial interviewer involvement and study clinician availability, it provided efficient risk management.

Impacts:
Mental health implementation research requires thorough and effective methods for ensuring patient safety from SI, particularly when patients are interviewed via phone. Our results support the effectiveness of a particular protocol.