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BACKGROUND/RATIONALE:
Though rare, suicide is not rare enough in VA settings. Early identification of suicidality and its risk factors is crucial for effective intervention to prevent this disastrous outcome. A recent study found that 45% of those who committed suicide had contact with a primary care provider (PCP) in the month prior to suicide, thus highlighting the importance of PCPs in identifying and intervening with the 2-3% of primary care patients who endorse suicidal ideation. The overall objective of this secondary data analysis project is to determine meaningful correlates of suicidality in the context of VA primary care that will prove useful to clinicians for effective detection and intervention. In addition, we will assess the preference-weighted health status (PWHS) associated with each meaningful correlate of suicidality (e.g. major depression, posttraumatic stress disorder, pain conditions) as a means to determine the health impact of these characteristics for veterans with and without suicidality. There are two primary objectives.
OBJECTIVE(S):
Objective 1: Determine the relationship of patient level characteristics and patterns of service use to suicidality in VA primary care patients. In addition to socio-demographic characteristics, we will study medical and psychiatric diagnoses, unrecognized psychiatric diagnoses, self-reported experience of pain, service use (primary care, mental health, and other specialty), service intensity, and medication management. For example, we will conduct analyses on the contribution of pain and pain-related medical diagnoses to suicidality and whether this is different in patients with recognized versus unrecognized psychiatric diagnoses.
Objective 2: Evaluate the PWHS of veterans with and without suicidality adjusting for medical and psychiatric comorbidity and other factors identified in Objective 1.PWHS scores exist for mental disorders commonly associated with suicide, like major depression and PTSD; however, the contribution of suicide to PWHS has yet to be explored. We will calculate PWHS in veterans with characteristics identified in Objective 1 and examine the relationship of suicidality.
METHODS:
We will make use of an extant dataset (developed from Dr. Magruders HSR&D grant # VCR-99-010-2) that is uniquely suited to explore all of the areas proposed in the research objectives. The analytic sample is comprised of 884 patients (82% of consenters) who were reached for telephone diagnostic interview. Based on recommended scoring of MINI Module C (suicidality), 8.71% of patients (77/884) were classified as a current suicide risk -- 2 to 4 times higher than in non-VA primary care.
We will focus on the following data sources: psychiatric diagnoses based on the MINI, PTSD based on the CAPS, suicidality based on the MINI, provider recognition of psychiatric disorders derived from a program comparing MINI/CAPS data and electronic medical record diagnoses (ICD-9 codes), pain conditions based on ICD-9 codes, pain management based on medication and pain clinic attendance, mental health management based on medication and mental health clinic attendance, service use patterns (primary care, mental health, and other specialty visits), medications (prescriptions, fill patterns), self-reported pain/functioning based on the SF-36 and 5th vital sign, preference-weighted health status derived from the SF-36.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
The project is innovative in that we will test in combination variables that have not previously been reported (e.g., pain and unrecognized psychiatric disorder), and PWHS has never been studied relative to suicidality in primary care. The results will provide useful information for VA to help in determining if screening for suicidality is warranted in VA primary care.
PUBLICATIONS:
None at this time.
DRA:
none
DRE:
none
Keywords:
none
MeSH Terms:
none
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