Suicidal Ideation is Common among OEF/OIF Veterans who Receive VA Healthcare
To identify Veterans at risk for suicide, prevention efforts have focused on suicidal ideation as an invariable precursor to – and perhaps the best single predictor of – suicide attempts. In 2007, VA implemented several suicide prevention initiatives, including required brief assessment for suicidal ideation among Veterans potentially at greater risk, such as those who screen positive for depression or PTSD. To facilitate assessments, electronic clinical reminders were developed and disseminated nationally. This study sought to determine the prevalence and correlates of suicidal ideation among OEF/OIF Veterans who screened positive for depression following implementation of the required brief assessments. Investigators identified 16,230 Veterans who received healthcare at one of three large, geographically and demographically distinct VAMCs between 4/08 and 9/09; of these Veterans, 8,912 (55%) were screened for depression, with 1,744 (20%) screening positive. Of those who screened positive, 1,340 (77%) were subsequently assessed for suicidal ideation using one of the two brief tools employed nationally (9th item of the PHQ-9 or VA Suicide Risk Pocket Card items). Socio-demographics, mental health diagnoses, psychiatric comorbidity, and PHQ-2 scores that assess the frequency of depressed mood and anhedonia (inability to experience pleasure) also were examined.
- Suicidal ideation is common among OEF/OIF Veterans who receive VA healthcare: one in three Veterans who screened positive for depression acknowledged possible suicidal ideation.
- High PHQ-2 scores (> 5) nearly doubled the odds of suicidal ideation, even when controlling for diagnoses of depression.
- Depression and bipolar or schizophrenia diagnoses significantly increased the odds of suicidal ideation. In addition, having a single diagnosed psychiatric disorder did not significantly increase the odds of suicidal ideation, but two disorders were associated with a 60% increase, and three or more disorders more than doubled the odds.
- In contrast to previous reports, this study found no increase in suicidal ideation for Veterans with PTSD, substance use disorders, anxiety disorders, or traumatic brain injury. However, the authors note that a recently published evidence-based synthesis concluded that despite mixed results, PTSD should be considered a risk factor for suicide attempts and completion among Veterans.
- Suicidal ideation was less likely among non-Hispanic white Veterans.
- This sample was limited to Veterans with positive depression screens. This study did not address psychotic, personality, or impulse control diagnoses, or psychosocial stressors (i.e., employment problems, relationship issues).
- This study did not address the reliability and validity of tools employed for the brief assessment of sucidal ideation.
This study was funded by HSR&D (DHI 08-096). Drs. Corson, Denneson, and Dobscha are part of HSR&D's Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders.
Corson K, Denneson LM, Bair MJ, Helmer DA, Goulet J, and Dobscha SK. Prevalence and Correlates of Suicidal Ideation among Operation Enduring Freedom and Operation Iraqi Freedom Veterans. Journal of Affective Disorders July 2013;149(1-3):291-298.