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Identifying Veterans at Risk For Suicidal Behavior. White Paper Report for VA Central Office Patient Services Leadership.
Bahraini N, Bossarte R, Brenner LA, Dobscha SK, Oslin D, Wendleton L. Identifying Veterans at Risk For Suicidal Behavior. White Paper Report for VA Central Office Patient Services Leadership. 2014 Jan 15.
The primary goal of suicide risk assessment is to identify Veterans in need of immediate intervention to prevent self-directed violence (VA/DoD). Suicide risk assessment can also serve to guide providers and healthcare systems in identifying which Veterans, at less acute risk, would benefit from enhanced care to prevent future suicidal behavior. Currently, clinicians are encouraged to assess each patient's level of risk (low, intermediate, high) based on evaluations of past or present suicidal ideation or behaviors, warning signs, and risk and protective factors (VA/DoD). Although there are questionnaires, individual questions, and clinical rating scales that have demonstrated associations with suicidal behavior that can aide clinicians in risk assessment, there are no evidence-based tools with psychometric properties adequate to support their routine use in clinical decision-making (Brown). This assertion is supported by findings from a systematic review conducted by the U.S. Preventative Services Task Force (Gaynes et al., 2004), in which the authors noted that no studies were identified which addressed "whether screening for suicide in primary care reduces morbidity and mortality."
As such, providers must rely on patient disclosure and clinical judgment when making decisions regarding suicide risk and recommendations for care. These current approaches require clinical skills and a level of comfort not possessed by all providers. In turn, those providing care are requesting tools such as decision aids; however, evidence continues to lag behind need.