Center to Improve Veteran Involvement in Care, VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), Portland, Oregon, USA.
Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Acad Emerg Med. 2023 Apr;30(4):321-330. doi: 10.1111/acem.14695. Epub 2023 Feb 27.
Many Veterans at high risk for suicide are identified in Veterans Health Administration (VHA) emergency departments (ED). Little is known about what may predict care utilization in this population. To address this knowledge gap, we explored factors associated with Veterans' lack of VHA care utilization following a positive suicide risk screen in the ED.
In a retrospective observational study, we identified all patients who were seen in a VHA ED from October 1, 2019, to September 30, 2020. We examined factors associated with not utilizing VHA mental health (MH) and all VHA care in the 6 months following a positive suicide ED screen. Predictors included comorbidity, homelessness, and MH visit and diagnosis history.
We identified 23,446 Veterans with a positive suicide risk screen in the ED in fiscal year 2020. Overall, 4.1% had no VHA MH visits 6 months postscreen. The probability of not utilizing MH care was significantly higher for Veterans with no comorbidity (4.7% vs. 3.4% for mild comorbidity), no MH diagnosis (10.5% vs 2.8%), no past-year MH visits (13.6% vs 2.3%), and no past-year homelessness (5.4% vs. 1.1%). A smaller proportion of the population did not receive any VHA care 6 months postscreen (0.5%). Veterans who did not experience homelessness (0.6% vs 0.2%), had no MH diagnosis (1.6% vs. 0.3%), and had no previous MH visits (1.9% vs 0.2%) were significantly more likely to not utilize VHA care.
Veterans who do not utilize VHA care after a positive suicide risk screen appear to have fewer documented health and housing concerns than those who do receive care. Yet, Veterans with a positive suicide risk screen who are otherwise healthy may remain at elevated risk for suicide following their ED visit. ED providers may consider enhanced follow-up care to mitigate suicide risk for these Veterans.
在退伍军人健康管理局 (VHA) 急诊部 (ED) 中，许多有自杀高风险的退伍军人得到了识别。对于这一人群的护理利用情况可能有哪些预测因素，人们知之甚少。为了解决这一知识空白，我们探讨了与 ED 中阳性自杀风险筛查后退伍军人缺乏 VHA 护理利用相关的因素。
在一项回顾性观察性研究中，我们确定了 2019 年 10 月 1 日至 2020 年 9 月 30 日期间在 VHA ED 就诊的所有患者。我们检查了与阳性 ED 筛查后 6 个月内不利用 VHA 心理健康 (MH) 和所有 VHA 护理相关的因素。预测因素包括合并症、无家可归和 MH 就诊和诊断史。
我们在 2020 财年确定了 23446 名 ED 中阳性自杀风险筛查的退伍军人。总体而言，有 4.1%的退伍军人在筛查后 6 个月内没有接受 VHA MH 就诊。无合并症（轻度合并症为 3.4%，无合并症为 4.7%）、无 MH 诊断（2.8%，无 MH 诊断为 10.5%）、无过去一年 MH 就诊（2.3%，无过去一年 MH 就诊为 13.6%）和无过去一年无家可归（1.1%，无过去一年无家可归为 5.4%）的退伍军人不利用 MH 护理的可能性显著更高。6 个月后，没有接受任何 VHA 护理的人群比例较小（0.5%）。没有经历过无家可归（0.2%，没有经历过无家可归为 0.6%）、没有 MH 诊断（0.3%，没有 MH 诊断为 1.6%）和没有过去 MH 就诊（0.2%，没有过去 MH 就诊为 1.9%）的退伍军人更有可能不利用 VHA 护理。
在阳性自杀风险筛查后不利用 VHA 护理的退伍军人似乎比接受护理的退伍军人有较少的记录健康和住房问题。然而，有阳性自杀风险筛查且其他方面健康的退伍军人在 ED 就诊后仍可能面临更高的自杀风险。ED 提供者可能会考虑加强随访护理，以降低这些退伍军人的自杀风险。
