Responding to Suicidal Ideation in an Observational Cohort Study

Bucy R, Hanisko K, Ewing L, Pfeiffer PN, Nallamothu BK, Iwashyna T. Responding to Suicidal Ideation in an Observational Cohort Study. Poster session presented at: University of Michigan Albert J. Silverman Annual Research Conference; 2016 Apr 27; Ann Arbor, MI.

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Responding to Suicidal Ideation in an Observational Cohort Study Bucy R, LMSW (1); Hanisko K, MPH (1); Ewing L, MPH (1); Pfeiffer P, MD (1, 2) Nallamothu BK, MD, MPH (1, 3); Iwashyna TJ, MD, PhD (1, 3, 4) (1) VA Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI (2) University of Michigan, Department of Psychiatry, Ann Arbor, MI (3) University of Michigan, Department of Internal Medicine, Ann Arbor, MI (4) University of Michigan, Institute for Social Research, Ann Arbor, MI Background: Suicide is one of the leading causes of death in the United States for all ages. Compared to the general U.S. population, formerly deployed Veterans have a 41% higher suicide rate. Depressive symptoms and explicit suicidality are crucially important outcomes of Veteran care that needs to be assessed in clinical studies, even if not directly related to suicide prevention. Objective: To assess the level of suicidality among Veterans using a specific protocol that guides research assistants in offering Veterans appropriate support and resources. Methods: Veterans who survived an in-hospital cardiac arrest (IHCA) during a prior admission were interviewed by phone at 3, 6, 9 and 12 months post-discharge from a U.S. Veterans Health Administration (VHA) Medical Center to assess quality of life and functional status. At each interview, Veterans were asked questions from the Patient Health Questionnaire (PHQ-9), an instrument used to identify mental health disorders. While other cohorts sometimes avoid the following question to evade having to respond to the answers, we felt it was important to directly ask: "In the past two weeks, how often have you been bothered by thoughts that you would be better off dead or of hurting yourself in some way?" If a Veteran answered anything but "Not at all", researchers followed a protocol using a brief script to ensure the patient was safe and equipped with appropriate resources. After the conversation, researchers completed a Patient Safety Screen (PSS) adapted from the Colombia-Suicide Severity Rating Scale (C-SSRS). Veterans were categorized by these levels of suicidality: passive ideation, active ideation, suicidal intent without a plan, suicidal thoughts with plan, and suicidal intent with specific plan. The PSS along with a brief summary explaining the course of action was sent to Principal Investigators and a Mental Health Practitioner Co-Investigator allowing review to assess whether additional follow-up was needed. Results: From December 2014 to February 2016, a total of 733 surveys were completed by Veterans with IHCA, 59 (8%) of which included a Veteran revealing any level of suicidality. Of those 59, 39 (66%) Veterans reported passive ideation and 3 (5%) reported active ideation. Three Veterans stated they had suicidal thoughts with a method, 1 without a method and 2 with a specific plan and intent on following through. Fourteen (24%) Veterans displayed suicidal ideation during more than one survey and 2 (3%) Veterans required additional follow-up with a mental health provider. In 33 (56%) cases the Veteran already had either a mental health provider or the number to the Veterans crisis line. Veterans were provided the crisis line in 13 (22%) cases. Based on available medical records, there have been no suicide attempts or completed suicides in the cohort. Conclusion: Suicidal ideation is not rare in Veterans, especially Veterans who are in poor health conditions. Addressing suicidality in an observational research study is feasible, but requires a detailed protocol, staff who can address the rare but unpredictable high risk needs and collaborative support from study Investigators.