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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3075 — Trust is the Basis for Effective Screening for Suicidal Ideation

Ganzini LK, Portland VAMC HSRD REAP; Press N, Oregon Health & Science University; Helmer DA, Michael DeBakey VAMC, Houston; Bair MJ, Center on Implementing Evidence Based Practice, Indianapolis; Poat J, Oregon Health & Science University; Dobscha SK, Portland VAMC HSRD REAP;

Objectives:
Each year approximately 6000 Veterans take their own lives and many more attempt suicide. The VA has attempted to improve identification of suicidal patients through mandatory screening for suicidal ideation (SI). Little is known about the impact of SI screening and how it is perceived by Veterans. The goal of this qualitative study was to explore OEF/OIF Veterans’ experiences with SI screening.

Methods:
Qualitative interviews were completed with 34 OEF/OIF Veterans enrolled at VA Medical Centers in Houston, Portland and Indianapolis, who screened positive for SI. Veterans were asked about experiences and perceptions of SI screening including memories, feelings, comfort, and honesty with the screens. Data were analyzed using the constant comparative method.

Results:
Many OIF/OEF Veterans were accustomed to being asked about suicidal thoughts, and they described the questions as straight forward and understandable. Most Veterans accepted the value of screening for disease in general, but some wondered if suicidal ideation was too sensitive and serious for standardized screening. They worried that admitting suicidal thoughts might lead to overreaction by providers or counter-therapeutic hospitalization. Some expressed negative, stigmatizing views of being suicidal as evidence of weakness or failing. This perception had been reinforced during military service. Many Veterans confessed they had not been previously honest on SI screening questions, denying pervasive and severe thoughts of self harm. Veterans reported they were untruthful on SI screens if screens were completed in a perfunctory manner, read off computer screens, or not integrated into care. Candid discussion of suicidal thoughts was enhanced when administered by a trusted, continuity provider who communicated genuine concern.

Implications:
The validity of SI screening may be improved if administered by trustworthy, continuity providers.

Impacts:
Accurate assessment of the presence and severity of SI may be improved if integrated into care with ongoing providers with whom the Veteran has developed trust.


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