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Health Services Research & Development

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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3032 — The Impact of Pain on Suicide Risk Screening Among Veterans in VA Care

Goulet JL (VACHS/Yale University), Brandt CA (VACHS/Yale University), Czlapinski RA (VACHS), Desai RA (VACHS/Yale University), Heapy A (VACHS/Yale University), Kerns RD (VACHS/Yale University)

Objectives:
Pain is associated with suicidal ideation and suicide. Pain screening occurs in most VA primary care clinic (PCC) visits. Suicide risk screening is conducted using the PHQ9 when the yearly PHQ2 depression screening is positive. We examined whether Veteran-reported pain impacts the conduct of depression and suicide screening.

Methods:
In an HSRandD project examining pain and suicide risk, we identified Veterans with PCC visits at the local facility in CY09, and, at each visit: pain numeric rating scale (NRS) scores; PHQ2 depression screening results; and PHQ9 results. We defined moderate or greater pain as an NRS of 4+, PHQ2 positive as a score of 3+, PHQ9 positive as a score of 10+, and suicidal ideation (SI) as any endorsement of PHQ9 item 9. We used generalized estimating equations to account for repeated visits.

Results:
There were 43,926 Veterans: 96% were male; 62% were white; and the mean age was 68. They had 90,182 visits verified by an associated VistA blood pressure; 96% had an NRS, 38% a PHQ2, and 0.9% a PHQ9. Over 25% of NRS indicated moderate pain, 3% of PHQ2 and 42% of PHQ9 were positive, and 18% of PHQ9 had were positive for SI. PHQ2 screening was less likely when moderate pain was reported (OR = 0.58, p < 0.0001), but was more likely to be positive when moderate pain was reported (OR = 3.91, p < 0.0001). In visits with a positive PHQ2, only 22% had a PHQ9. Moderate pain was not associated with the conduct of a PHQ9 (OR = 0.97, p = 0.8). However, moderate pain was associated with a positive PHQ9 (OR = 1.35, p < 0.001) and with SI (OR = 1.45, p < 0.05).

Implications:
Veterans reporting moderate or greater pain are less likely to be screened for depression. There is a low rate of PHQ9 follow-up to positive depression screens, and Veterans reporting pain are equally unlikely to be assessed. Ongoing chart review will examine whether other methods are used to assess suicide risk in this vulnerable population.

Impacts:
This study adds to a growing empirical literature documenting an association between pain and suicidal ideation. Lack of depression screening follow-up may result in a missed opportunity to identify suicide risks among Veterans in care.


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