Detection of Suicidal Ideation Not Associated with Increased Mental Health Utilization in Year Following SI Assessment
Suicidal ideation (SI) is among one of the best predictors of suicide attempts. Thus, VA has designated the assessment of SI among Veterans with positive screens for depression or PTSD as a national performance goal since 2008. However, the relationship between suicide risk assessment programs and treatment utilization is not well understood. This multi-site study evaluated the impact of brief SI assessments on mental healthcare use among new-to-care (no VA healthcare visits during five years prior to study period) OEF/OIF Veterans. Investigators identified 465 Veterans who screened positive for depression between 4/08 and 9/09 in a primary care or mental health outpatient setting at one of three VAMCs that represented the Northwestern, Southwestern, and Northeastern regions of the US. Study measures included: depression, suicidal ideation, demographics, and healthcare data (i.e., other clinical diagnoses such as PTSD, substance use disorder, anxiety disorder).
- Of the 465 Veterans in this study, 147 (32%) had positive SI assessment results. The detection and presence of suicidal ideation was not associated with subsequent mental healthcare utilization over the following year, when accounting for the severity of depression symptoms. In other words, SI itself was not found to be associated with increased Veteran engagement in specialty mental healthcare over and above depression symptom severity.
- When a Veteran's inaugural visit to VA healthcare included a mental health clinician, the Veteran was more likely to attend more subsequent specialty mental health visits – and to receive an antidepressant medication – than Veterans who were seen by a primary care clinician only.
- In the year following SI assessment, 377 Veterans (81%) had at least one mental health visit, 248 (53%) filled an antidepressant prescription, and 24 (5%) had a psychiatric inpatient stay.
- It is possible that the SI assessment program had indirect/unmeasured effects on mental healthcare, e.g., through increased awareness of suicide risk or detection of mental illness.
- Investigators were unable to assess the validity and reliability of measures used to detect SI.
- Previous work has shown that OEF/OIF Veterans seen in integrated primary care/mental health clinics may be more likely to accept referrals to specialty mental healthcare than Veterans of other eras, but are not more likely to actually attend subsequent specialty mental healthcare appointments stemming from referrals. The current study found that results of SI assessment may not impact Veteran engagement in recommended specialty mental health treatment. Self-selection into mental healthcare may be a larger driver of continued treatment than referrals from non-mental health clinicians. Finding ways to support initiation and continued engagement in mental healthcare may be a more effective means to increase mental health utilization than risk detection efforts in non-mental health settings.
This study was funded by HSR&D (DHI 08-096). Drs. Denneson, Corson, and Dobscha are part of HSR&D's Center to Improve Veteran Involvement in Care, located in Portland, OR.
Denneson L, Corson K, Helmer D, Bair M, and Dobscha S. Mental Health Utilization of New-to-Care Iraq and Afghanistan Veterans following Suicidal Ideation Assessment. Psychiatry Research. July 30, 2014;217(3):147-53.