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Response to Commentary

VA Research and Partner Collaboration Brings Focus to Veteran Suicide Prevention

The VA Office of Research and Development (ORD) understands and agrees with Dr. Miller’s challenge to become more ‘nimble and responsive’ to the needs of its operational partners – and ORD has already initiated steps in this direction. Dr. Miller closed his commentary by citing ongoing re-organization efforts within ORD and discussing his expectations for enhanced collaboration between ORD and the Suicide Prevention Program (SPP; part of the VA Office of Mental Health and Suicide Prevention) in support of the overall VA suicide prevention effort. ORD is in the process of transitioning from a research program that is organized based on research methods to one structured by and responsive to specific diseases or clinical challenges within the Veteran community.

For decades, ORD disbursed research funding through services that were defined by research methods and techniques ranging from basic science to health systems-based investigations; this approach emphasized the full research to practice translational pipeline. With this model, suicide prevention research has been supported across all ORD services, ensuring the topic was studied from a range of perspectives; however, this model has also been a barrier to efficient management of the overall portfolio and restricted the capacity of ORD to respond to urgent needs of VHA leadership.

The aims of the ORD reorganization are to preserve the advantages of discipline-focused research while at the same time increasing ORD’s capacity to coordinate research efforts within a particular topic area. The reorganization will create opportunities to address the immediate needs of our clinical program partners. Beginning in FY25, ORD will be organized into four broad portfolios of wide-ranging interests, with additional, Actively Managed Portfolios (AMPs) that are focused on relatively narrow health concerns. One of these AMPs is being designed specifically to support suicide prevention research.

What does this mean for VA suicide prevention research? First, this new model allows a continued emphasis on investigator-initiated suicide prevention research efforts, which have yielded several innovative ideas over the years. However, to improve responsiveness to the needs of clinical partners and the Veteran community, the Suicide Prevention AMP also will release time limited, focused Research Funding Announcements (RFA) that address specific priorities of VA operational partners. These priorities will be established by an Executive Steering Committee that will consider input from relevant program offices, field clinicians and investigators, and the broader Veteran community. The release of focused RFAs is intended to guide the field into important but understudied areas of inquiry relevant to suicide prevention. Additionally, the Suicide Prevention AMP will create funding opportunities for investigators to develop enterprise-wide resources that address structural barriers inherent in suicide prevention research. Thus, the creation of the Suicide Prevention AMP is intended to support and grow investigator-initiated research while simultaneously increasing research that addresses key gaps. We expect this to result in collaborations with clinical partners that identify ways to translate research findings more quickly into practice.

Although the Suicide Prevention AMP will not formally commence until FY25, ORD already has established enterprise-wide resources to support the VA suicide prevention research community. Primary among these is the Suicide Prevention Research Impact Network (SPRINT). This resource center, now jointly funded by HSR&D and CSR&D, is self-described as “a national collaborative network of VHA researchers and operations partners and seeks to maintain up-to-date information about VA suicide prevention research and operations projects, collaborate with SPP to identify research priorities, facilitate development of innovative research proposals through a planning award mechanism and field-based meetings, and foster professional development among suicide prevention researchers.” In four years, SPRINT has not only established a strong working relationship with the SPP and formalized a network of VA investigators, it has also built critical links with other federal agencies that support research in this area.

One of SPRINT’s most impressive contributions to VA has been the implementation of planning awards to both new and experienced investigators. Over three years, SPRINT has peer-reviewed and funded 15 studies as planning awards that have begun to target the range of topics cited by Dr. Miller. Planning awards include studies on the use of social determinants of health to help identify Veterans at risk for suicide, perceptions of suicide-related care for LGBTQ Veterans, and implementation barriers to lethal means management by pharmacies in rural communities.

Another resource is the Suicide Prevention Trials Database, which provides “a publicly available and up-to-date database of study-level data from published trials of suicide prevention approaches.” This database, updated quarterly, is being developed to support future research-related activities, such as supporting OMHSP in the development of clinical practice guidelines, highlighting research gaps, and informing the planning stages of new research.

Currently, ORD supports almost 80 merit awards and pilot studies with a primary or secondary focus on suicide prevention. Following HSR&D guidelines, researchers developed many of these studies with at least some level of consultation with OMHSP/SPP staff to ensure the utility of the research in addressing VA needs in reducing Veteran suicide. The ongoing reporting of study progress and findings to OMHSP/SPP is a feature of this ongoing work.

Key studies in our overall Suicide Prevention Portfolio already are addressing OMHSP needs by investigating topics around lethal means safety, gatekeeper training, social determinants of health, and public messaging to Veterans and community stakeholders. Researchers are testing efficacious interventions, including caring contacts, the Virtual Hope Box, treatment within a Dialectical Behavior Therapy Skills Group, Transcranial Magnetic Stimulation, and cognitive behavioral therapy for insomnia. As for study populations, these studies target a wide range of critical study groups such as women Veterans, Veterans experiencing homelessness, LGBTQ Veterans, Veterans not receiving VHA services, and aging Veterans.

Impacts from these studies are already being felt in the field. An HSR&D Innovation award – Development and Evaluation of a Veteran-Informed Means Restriction Intervention for Suicide Prevention – investigated strategies for engaging community stakeholders in helping employ community-based, safe storage programs for Veterans at high risk for suicide. In a short time, this novel approach has been expanded from a pilot involving three firearm retailers to 14 sites with continued expansion planned based on OMHSP support. Another study – Using Big Data and Machine Learning to Understand the Association Between Altitude and Suicide among Veterans – is answering a Congressional research question by applying innovative analytic methods that have confirmed the association between altitude and suicide. This study is now investigating the interaction between geospatial location and social determinants in understanding suicide risk.

Finally, in looking beyond our current efforts, we also foresee a productive future for suicide prevention research based on having more than 20 individuals involved in ORD career development and capacity building programs, all involved in research efforts with a primary or secondary focus on suicide prevention. In addition, ORD supports three Research Career Scientists and two Diversity, Equity, and Inclusion Summer Research Program awardees who are focusing on suicide prevention research. Finally, true to its mission, SPRINT has developed a robust, ongoing early career investigator initiative that provides regular consultation and networking activities for both senior and junior researchers new to the field of suicide prevention research.

We look forward to ever increasing collaboration with OMHSP, bringing the impressive skillsets of our investigators to the forefront of our research contribution to VA’s top clinical goal: ending Veteran suicide.