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BACKGROUND/RATIONALE:
Suicide is up to twice as prevalent among veterans compared to non-veterans. The VA has introduced a new national performance measure requiring suicidal ideation (SI) screening for all veterans with positive annual depression screens. To date, however, there is little empirical evidence supporting that SI screening leads to improved outcomes such as further assessment or treatment for depression or comorbid conditions. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans often have risk factors for suicide. It is important to know if the VA's new screening process facilitates delivery of timely and appropriate mental health care.
OBJECTIVE(S):
The main objective of this study is to identify process outcomes among OEF/OIF veterans with depression who are screened for SI in Veterans Affairs (VA) facilities. Specifically we will 1) Identify the prevalence of positive SI screens among OEF/OIF veterans who screen positive for depression, 2) Compare post-screen processes of care of depressed veterans with positive SI screens to depressed veterans with negative SI screens, 3) Identify important correlates of positive SI screens, and 4) Explore veterans' experiences of SI screening and their perceptions of clinicians' responses to screen results. As an additional aim, we also will identify process outcomes following positive SI screens and identify correlates of positive SI screens among non-OEF/OIF veterans who were screened with the PHQ-9.
METHODS:
This multi-site, mixed-methods study will be conducted at 3 VA facilities (Portland, Houston, and Indianapolis), and will involve collection of quantitative data from local facility databases and collection of qualitative information from interviews of 45 veterans screened for SI. We will collect data from administrative databases of the 3 VA facilities for all veterans screened with the Patient Health Questionnaire-9 (PHQ-9) over 12 months, and determine the prevalence of initial SI screens (endorsement of PHQ-9 9th item) among veterans meeting criteria for major depression (PHQ-2>=3). Using administrative databases and medical record review, we will compare veterans with depression and SI (estimated N>=400) to veterans with depression but no SI (estimated N>=1,000) on demographics, depression severity, medical morbidity, International Classification of Diseases (ICD-9) diagnoses (depression, substance use disorder (SUD), post-traumatic stress disorder [PTSD]), and clinic screen results (depression, alcohol, PTSD, pain, traumatic brain injury) documented in the 12 months prior to screening. Logistic regression will be used to identify correlates of positive SI screens. Then, for the 12 months after screening, we will identify approaches used to address positive SI screens at each site and measure engagement with healthcare, new psychiatric diagnoses (depression, PTSD, SUD), treatment with antidepressants, and all-cause mortality. We will compare depressed veterans with SI to depressed veterans without SI, and compare OEF/OIF cases to non-OEF/OIF cases and controls). Finally, we will conduct individual interviews with a purposive sample of 15 of OEF/OIF veterans with SI from each study site to learn more about perceptions of SI screening and the healthcare system's response to screening. Constant comparative method will be used to analyze qualitative data.
FINDINGS/RESULTS:
This is a new project.
IMPACT:
This study will improve care for Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans by increasing knowledge of the effectiveness of a new Veterans Affairs (VA) program for screening for suicidal ideation (SI). We will learn about risk factors for SI among OEF/OIF and non-OEF/OIF veterans. Results will guide further research and the development of new screening approaches and interventions.
PUBLICATIONS:
None at this time.
DRA:
Mental Illness, Military and Environmental Exposures
DRE:
Prevention, Quality of Care
Keywords:
Depression, Screening, Deployment Related
MeSH Terms:
none
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