Rocky Mountain Mental Illness Research, Education and Clinical Center, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado.
Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz School of Medicine, Aurora.
JAMA Netw Open. 2020 Oct 1;3(10):e2022531. doi: 10.1001/jamanetworkopen.2020.22531.
In 2018, the Veterans Health Administration (VHA) implemented the Veterans Affairs (VA) Suicide Risk Identification Strategy to improve the identification and management of suicide risk among veterans receiving VHA care.
To examine the prevalence of positive suicide screening results among veterans in ambulatory care and emergency departments (EDs) or urgent care clinics (UCCs) and to compare acuity of suicide risk among patients screened in these settings.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the VA's Corporate Data Warehouse (CDW) to assess veterans with at least 1 ambulatory care visit (n = 4 101 685) or ED or UCC visit (n = 1 044 056) at 140 VHA medical centers from October 1, 2018, through September 30, 2019.
Standardized suicide risk screening and evaluation tools.
One-year rate of suicide risk screening and evaluation, prevalence of positive primary and secondary suicide risk screening results, and levels of acute and chronic risk based on the VHA's Comprehensive Suicide Risk Evaluation.
A total of 4 101 685 veterans in ambulatory care settings (mean [SD] age, 62.3 [16.4] years; 3 771 379 [91.9%] male; 2 996 974 [73.1%] White) and 1 044 056 veterans in ED or UCC settings (mean [SD] age, 59.2 [16.2] years; 932 319 [89.3%] male; 688 559 [66.0%] White) received the primary suicide screening. The prevalence of positive suicide screening results was 3.5% for primary screening and 0.4% for secondary screening in ambulatory care and 3.6% for primary screening and 2.1% in secondary screening for ED and UCC settings. Compared with veterans screened in ambulatory care, those screened in the ED or UCC were more likely to endorse suicidal ideation with intent (odds ratio [OR], 4.55; 95% CI, 4.37-4.74; P < .001), specific plan (OR, 3.16; 95% CI, 3.04-3.29; P < .001), and recent suicidal behavior (OR, 1.95; 95% CI, 1.87-2.03; P < .001) during secondary screening. Among the patients who received a Comprehensive Suicide Risk Evaluation, those in ED or UCC settings were more likely than those in ambulatory care settings to be at high acute risk (34.1% vs 8.5%; P < .001).
In this cross-sectional study, population-based suicide risk screening and evaluation in VHA ambulatory care and ED or UCC settings may help identify risk among patients who may not be receiving mental health treatment. Higher acuity of risk among veterans in ED or UCC settings compared with those in ambulatory care settings highlights the importance of scaling up implementation of brief evidence-based interventions in the ED or UCC to reduce suicidal behavior.
2018 年，退伍军人事务部（VA）实施了 VA 自杀风险识别策略，以提高接受 VA 护理的退伍军人自杀风险的识别和管理。
调查在门诊和急诊部（ED）或紧急护理诊所（UCC）接受治疗的退伍军人中阳性自杀筛查结果的流行率，并比较这些环境中筛查患者的自杀风险严重程度。
设计、地点和参与者：这项横断面研究使用了 VA 企业数据仓库（CDW）的数据，评估了在 140 个 VA 医疗中心接受至少 1 次门诊就诊（n=4101685）或 ED 或 UCC 就诊（n=1044056）的退伍军人。数据采集时间为 2018 年 10 月 1 日至 2019 年 9 月 30 日。
标准化自杀风险筛查和评估工具。
一年内自杀风险筛查和评估的发生率、初级和二级自杀风险筛查阳性结果的流行率，以及根据 VA 的综合自杀风险评估得出的急性和慢性风险水平。
在门诊环境中共有 4101685 名退伍军人（平均[SD]年龄，62.3[16.4]岁；3771379[91.9%]为男性；2996974[73.1%]为白人）和 1044056 名退伍军人在 ED 或 UCC 环境中接受了初级自杀筛查。初级筛查阳性的自杀筛查结果发生率为 3.5%，二级筛查为 0.4%；ED 和 UCC 环境中初级筛查阳性的自杀筛查结果发生率为 3.6%，二级筛查为 2.1%。与在门诊接受筛查的退伍军人相比，在 ED 或 UCC 接受筛查的退伍军人更有可能表示存在自杀意念（OR，4.55；95%CI，4.37-4.74；P<0.001）、具体计划（OR，3.16；95%CI，3.04-3.29；P<0.001）和最近的自杀行为（OR，1.95；95%CI，1.87-2.03；P<0.001）。在接受综合自杀风险评估的患者中，ED 或 UCC 环境中的患者比门诊环境中的患者更有可能处于高急性风险（34.1%比 8.5%；P<0.001）。
在这项横断面研究中，VA 门诊和 ED 或 UCC 环境中的基于人群的自杀风险筛查和评估可能有助于识别可能未接受心理健康治疗的患者的风险。与门诊环境相比，ED 或 UCC 环境中的退伍军人风险严重程度更高，这突出表明需要扩大实施基于证据的简短干预措施，以减少自杀行为。
