August 2017

In this Issue: Suicide Prevention
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Enhancing Veterans' Social Relationships to Optimize Depression Care

Feature Article

Among individuals with depression, having close social relationships and involving them in their treatment is associated with lower rates of depression, reduced suicide risk, higher rates of treatment initiation and adherence, better self-management skills, and higher satisfaction with care. Though many close relationships appear willing to participate in patients' care, in clinical practice, they are often not formally engaged in Veterans' depression care.

Strikingly little research has addressed the involvement of close relations in depression care. Specific mechanisms and processes for involving close relations that might improve depression outcomes have not been elucidated. Further, measures are lacking to identify whether close relation involvement is supportive and treatment-promoting, and integrating involvement of close relations into primary care-based mental health treatment is poorly understood. Thus, this ongoing, prospective cohort study of 300 VA primary care patients with depression seeks to identify to what extent several social processes (e.g., social support, interpersonal conflict, and social norms) are longitudinally associated with medication adherence, treatment engagement, help-seeking, self-management, suicidal ideation and behaviors, depression severity, patient activation and self-efficacy.

Study results will highlight which specific aspects of Veterans' close relationships should be the focus of a pilot intervention. Findings also will support the proposal for a larger study to determine the extent to which social processes predict development of incident major depressive disorder and suicide behaviors in Veterans. This proposed randomized controlled trial will include an intervention designed for implementation in VA primary care settings.

Impact: Major depression is a top health services priority because of its high prevalence among Veterans, large impact on quality of life, and close association with suicide. The anticipated impact of this project directly addresses several VA and HSR&D priority areas including involvement of Veterans' loved ones in care, upstream approaches to suicide prevention, primary care-mental health integration, and Veteran-centered care via active participation of Veterans' and their close relations.

Principal Investigator: Alan Teo, MD, MS, an HSR&D affiliate investigator, is an HSR&D Career Development Awardee and part of HSR&D's Center to Improve Veteran Involvement in Care.

Nelson H, Denneson L, Low A, et al. Suicide risk assessment and prevention: A systematic review focusing on Veterans. Psychiatric Services. June 15, 2017; Epub ahead of print.

Enhancing Veterans' Social Relationships to Optimize Depression Care project abstract