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Suicide Risk Evaluations and Suicide in the Veterans Health Administration
Kevin G Saulnier1,2,3, Courtney L Bagge2,3, Dara Ganoczy3
1Veterans Affairs (VA) Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health, Ann Arbor, Michigan.
JAMA Network Open
|February 25, 2025
Summary
Suicidal ideation, firearm access, and preparatory behaviors are key indicators of suicide risk within 30 and 365 days. These findings from the Comprehensive Suicide Risk Evaluation (CSRE) can improve veteran suicide prevention efforts.
Area of Science:
- Psychiatry
- Public Health
- Health Services Research
Background:
- The Veterans Health Administration (VHA) implemented the Comprehensive Suicide Risk Evaluation (CSRE) in 2019 to standardize suicide risk assessment.
- Identifying specific CSRE responses linked to suicide is crucial for refining risk management strategies and preventing suicides within the VHA system.
Purpose of the Study:
- To identify specific responses within the CSRE that are associated with subsequent suicide among VHA patients.
- To analyze acute (within 30 days) and chronic (within 365 days) suicide risk following CSRE administration.
Main Methods:
- A cohort study analyzed 269,374 CSREs administered to US VHA patients between November 2019 and December 2020.
- Suicide outcomes were determined using death certificate data, with analyses employing multivariable Cox proportional hazards regression.
- Exposures included CSRE responses such as suicidal ideation, behaviors, warning signs, risk factors, and protective factors.
Main Results:
- Suicidal ideation, firearm access, making preparations for suicide, seeking lethal means, anxiety, and psychiatric hospitalization history were associated with increased suicide risk within 30 days.
- Within 365 days, suicidal ideation, firearm access, preparatory behaviors, reckless behaviors, and psychiatric hospitalization history were linked to higher suicide risk.
- Anger was associated with decreased suicide risk in both acute and chronic periods. Recent transition from military service was also linked to decreased chronic risk.
Conclusions:
- The study identified specific CSRE responses, notably suicidal ideation, firearm access, and preparatory behaviors, as significant predictors of suicide risk.
- Findings suggest that incorporating these key CSRE constructs into risk prediction algorithms could enhance clinical suicide risk evaluations.
- These insights can inform targeted interventions and improve suicide prevention strategies within the VHA.
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