Factors associated with a lack of health care utilization among Veterans after a positive suicide screen in the emergency department.

Laliberte AZ, Salvi A, Hooker E, Roth B, Handley R, Carlson K, Hynes D, Tuepker A, Chen JI. Factors associated with a lack of health care utilization among Veterans after a positive suicide screen in the emergency department. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2023 Apr 1; 30(4):321-330.

Related HSR&D Project(s)

• IIR 21-218 – Serving All Who Have Served: Enhancing Suicide-Related Care Quality for Black, Indigenous, and People of Color Veterans
• IIR 20-165 – Care Coordination and Outcomes for High Risk Patients: Building the Evidence for Implementation
• RCS 21-136 – Research Career Scientist Award
• IIR 19-445 – Community Care Utilization among Post-9/11 Veterans with Traumatic Brain Injury

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Abstract:

OBJECTIVES: Many Veterans at high risk for suicide are identified in Veterans Health Administration (VHA) emergency departments (ED). Little is known about what may predict care utilization in this population. To address this knowledge gap, we explored factors associated with Veterans'' lack of VHA care utilization following a positive suicide risk screen in the ED. METHODS: In a retrospective observational study, we identified all patients who were seen in a VHA ED from October 1, 2019, to September 30, 2020. We examined factors associated with not utilizing VHA mental health (MH) and all VHA care in the 6?months following a positive suicide ED screen. Predictors included comorbidity, homelessness, and MH visit and diagnosis history. RESULTS: We identified 23,446 Veterans with a positive suicide risk screen in the ED in fiscal year 2020. Overall, 4.1% had no VHA MH visits 6?months postscreen. The probability of not utilizing MH care was significantly higher for Veterans with no comorbidity (4.7% vs. 3.4% for mild comorbidity), no MH diagnosis (10.5% vs 2.8%), no past-year MH visits (13.6% vs 2.3%), and no past-year homelessness (5.4% vs. 1.1%). A smaller proportion of the population did not receive any VHA care 6?months postscreen (0.5%). Veterans who did not experience homelessness (0.6% vs 0.2%), had no MH diagnosis (1.6% vs. 0.3%), and had no previous MH visits (1.9% vs 0.2%) were significantly more likely to not utilize VHA care. CONCLUSIONS: Veterans who do not utilize VHA care after a positive suicide risk screen appear to have fewer documented health and housing concerns than those who do receive care. Yet, Veterans with a positive suicide risk screen who are otherwise healthy may remain at elevated risk for suicide following their ED visit. ED providers may consider enhanced follow-up care to mitigate suicide risk for these Veterans.