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|Issue 108||February 2016|
The report is a product of the VA/HSR&D Evidence Synthesis Program.
Systematic Review: Suicide Prevention in Veterans
Veterans and military personnel represent 20% of suicides in the US. Rates of suicide increased during the wars in Afghanistan and Iraq – and between 2000 and 2010, the suicide rate among Veterans rose to exceed the rate among civilians. Female Veterans are at especially high risk relative to other women. These trends have led to new initiatives within the VA and military to address suicide prevention. In addition to individual-level approaches to suicide prevention, initiatives have been implemented at organizational, health system, and community levels. However, very few studies demonstrating their efficacy and effectiveness have been published. As a result, their influence on suicide prevention remains unclear.
Conducted by investigators with the VA Evidence-Based Synthesis Program (ESP) Center located at the VA Portland Health Care System, this systematic review updates evidence in three key areas:
ESP investigators reviewed the literature from January 2008 to September 2015 and identified 28 recently published studies, in addition to 9 studies from previous ESP reviews that met inclusion criteria. Of these 37 studies, 5 included Veterans and 4 included active military personnel.
Studies suggested that some population-level suicide prevention interventions and individual therapies in active military populations reduced suicide attempts and suicide. Suicide rates were lower after interventions in six observational studies, including studies of the Air Force Suicide Prevention Program, a program for an Army Infantry Division deployed to Iraq, and studies of police, college students, and health systems. Promising interventions comprised multiple prevention approaches operating together, and were directed at both soldiers and their surrounding social network (i.e., family or military commanders). Three examples of prevention approaches that were successfully combined include suicide prevention education, resiliency training, and monitoring of suicide events and trends.
In addition, adverse events should be measured and included as an outcome in future research, particularly intervention studies. Finally, further testing of novel and innovative approaches supported by existing developmental work is warranted. Examples include risk-assessment methods measuring objective markers of suicide risk, restricting access to lethal means of killing oneself, and use of technology or peer-support programs to enhance care in high-risk groups.
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ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of VA/HSR&D's Quality Enhancement Research Initiative's (QUERI) Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers – and to disseminate these reports throughout VA.
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