1082 — Suicide Risk Assessments Received by Veterans with a History of Depression Dying by Suicide: A Comprehensive Chart Review
Smith EG, Bedford COE, CHQOER/UMass Med School; Ganoczy D, Kim HM, Stano C, Ilgen MA, and Valenstein M, Ann Arbor COE/SMITREC;
To determine the quality of suicide risk assessment provided to Veterans with a history of depression dying by suicide between 1999-2004.
We reviewed medical charts from Veterans with a history of depression (240 Veterans dying by suicide/240 control patients matched by date, age, sex, and geographic region). To provide an especially detailed view of clinician-patient encounters prior to suicide, we examined clinicians’ recorded assessments of a wide range of suicide risk factors, including mental health and somatic symptoms, alcohol/substance abuse, prior suicide attempts, suicidal ideation and planning, and current access to means.
Rates of assessment of suicidal ideation in the year prior to suicide were significantly higher for Veterans who died from suicide than control patients (74% versus 60%, p = .001). Patients dying by suicide also had statistically comparable or greater levels of assessment than control patients for all other suicide risk factors examined. However, rates of suicidal ideation assessment at the final visit were substantially lower (30% for suicide deaths versus 20% for control patients, p = .012), and assessment of suicidal ideation was much more likely during a final visit with mental health than non-mental health services (61% versus 11%, p <.0001). Documented assessment of accessible means for suicide was minimal (<3%). Among those most likely to have suicidal ideation at time of final visit (Veterans completing suicide within the next 7 days), only 24% had an assessment of suicidal ideation recorded at their final visit, and only 30% of those asked endorsed suicidal ideation.
Suicidal ideation assessment rates were higher among Veterans who died by suicide than control patients. However, less than one-third of suicide decedents had suicidal ideation assessed at their final VHA visit, and less than one-third endorsed suicidal ideation when asked.
Our study supports efforts to routinize suicide risk assessment, destigmatize discussions of suicidal ideation, increase referrals to mental health services, and adopt broader suicide prevention strategies (all recent VHA initiatives). However, our data also indicate that traditional assessments (which frequently depend upon clinician judgment to determine when additional suicide risk assessment is needed, and upon the accuracy of patients’ self-report of suicidal ideation) may have significant limitations.