Screening for Suicidal Ideation among OEF/OIF Veterans with Positive Depression Screens

Dobscha SK, Corson K, Helmer DA, Bair MJ, Denneson LM, Duckart JP, Brandt C, Ganzini LK. Screening for Suicidal Ideation among OEF/OIF Veterans with Positive Depression Screens. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 19; National Harbor, MD.

Objectives: In 2008, VA began systematic screening for suicidal ideation (SI). We sought to identify rates of SI screening among a sample of OEF/OIF Veterans who had positive depression screens, and to identify patient, provider, and site correlates of receipt of screening for SI. Methods: VA administrative databases were used to identify Veterans who were screened for depression in ambulatory settings of three large, urban VA Medical Centers in different geographic regions between April 2008 and September 2009. Depression screening was conducted using the Patient Health Questionnaire (PHQ)-2 or PHQ-9. SI screening processes and scoring algorithms varied across the three sites. Manual medical record review was used to collect screen results. Results: Of 8,912 OEF/OIF Veterans screened for depression at the three sites, 15% to 25% had positive depression screens. Of the 1,744 Veterans with positive depression screens, 96% received their screenings in primary care or mental health settings. Thirty-nine percent of Veterans were new to VA care. Seventy-five percent to 85% were screened for SI within 30 days of their positive depression screens; 90% to 96% of these screens were conducted on the same days as depression screens. In multivariate analyses, SI screens were more likely to occur when the depression screen was administered by a nurse or medical assistant (OR = 1.70; CI:1.24-2.32) or mental health clinician (OR = 2.03; CI:1.44-2.85), compared to other types of staff. Male sex (OR = 1.53; CI:1.04-2.25), and diagnoses of major depression (OR = 1.57; CI: 1.20-2.04) or traumatic brain injury (OR = 2.37; CI:1.19-4.72) were associated with receipt of SI screening. Patients who had been in VA care > 1 year (OR = .63: CI:.46-.86) and Hispanic patients (OR = .68; CI:47-.98) were less likely to receive SI screening. Implications: Most OEF/OIF Veterans with positive depression screens are screened for SI. SI screening is more likely to occur when conducted by nurses, medical assistants, or mental health clinicians. Veterans who are new to care are more likely to receive SI screening than Veterans who are established in VA care. Impacts: Many aspects of the VA SI screening initiative have been implemented. SI screening location and processes may be more important than Veteran characteristics in determining who receives SI screening.