Study Suggests Veterans who Commit Suicide May Not Show Apparent Emotional Distress During Last Healthcare Contact
BACKGROUND:
Veterans are twice as likely to die by suicide compared to non-veterans, and as many as 5,000 Veterans take their own lives each year. Research indicates that as many as 45% of individuals who commit suicide contacted their primary care clinicians prior to death, and 19% contacted their mental healthcare clinicians. But little is known about the content of healthcare contacts prior to suicides committed by Veterans – or what opportunities might exist for intervention. This retrospective study examined VA healthcare contacts (by phone or in person) by Veterans in the year prior to their deaths by suicide. Using VA administrative data, as well as data from the Oregon Violent Death Reporting System, investigators identified 112 Veterans who committed suicide in Oregon between 2000 and 2005, and who had one or more healthcare-related contacts with one VAMC in the year prior to death. Investigators then manually reviewed medical records to determine whether any clinician assessed the Veterans for depression, substance use disorder, PTSD, or suicidal ideation during that year.
FINDINGS:
- The majority of Veterans in this study were seen for routine VA medical care in the year prior to committing suicide, and did not show apparent signs of emotional distress at their last healthcare visit.
- In the year prior to death, nearly 50% of the Veterans had one or more mental health contacts, and 63% had one or more primary care contacts. Just over half of the Veterans received care in the 30 days prior to death, with 20% receiving mental health care and 15% receiving primary care.
- Forty percent of these Veterans were assessed for suicidal ideation during the year prior to death, and 16% were assessed during their last contact. Nearly three-quarters of those who were specifically asked about thoughts of suicide in the year prior to death denied having such thoughts.
- The median number of days between final VA healthcare contact and date of death was 42. Of the 26 Veterans whose final contacts were with mental health, 87% were assessed for depression, substance use disorder, or PTSD, and 54% were assessed for suicidal ideation. Of the 22 Veterans whose final contacts were with primary care, 55% were assessed for depression, substance use disorder, or PTSD, and 9% were assessed for suicidal ideation.
LIMITATIONS:
- Data gathered through medical record review are limited by what the clinician documents. For example, if a clinician received a negative response to inquiries about depression or suicide, he or she might not have noted this in the chart.
- The time period studied predates recent enhancements in VHA suicide prevention programs which have included increased education and expanded use of screening for suicidal ideation and emphasis on suicide risk assessment.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (DHI 08-096). Dr. Denneson and Ms. Dickinson are part of HSR&D’s Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders.
Denneson L, Basham C, Dickinson K, et al. Suicide Risk Assessment and Content of VA Healthcare Contacts Prior to Suicide Completion in Oregon. Psychiatric Services December 2010;61(12):1192-97.
