School of Social Work, Saint Louis University, St. Louis, MO 63103, USA.
U.S. Department of Veterans Affairs, Central Arkansas Veterans Affairs Health Care System, HSR&D Center of Innovation: Center for Mental Healthcare & Outcomes Research, North Little Rock, AR 72118, USA.
Mil Med. 2023 Nov 3;188(11-12):e3289-e3294. doi: 10.1093/milmed/usad144.
This evaluation examined the role of safety plans, one of a host of clinical suicide prevention interventions available for veterans through the United States Department of Veterans Affairs' national network of health care facilities managed by the Veterans Health Administration (VHA).
Interviews were conducted with veterans who had experienced suicidal ideation or a suicide attempt since enrolling in the Department of Veterans Affairs health care system (N = 29). Topics included negative life experiences, triggers for suicidal ideation or a suicide attempt, ability to recall and utilize safety plans in crisis, safety plan elements found most and least useful, and improvements to safety planning.
Eighteen (62.07%) of the veterans in the sample had attempted suicide. Drug use was by far the most triggering and overdose was the most negative life event to subsequent ideation or attempt. Although all at-risk veterans should have a safety plan, only 13 (44.38%) created a safety plan, whereas 15 (51.72%) could not recall ever creating a safety plan with their provider. Among those who did recall making a safety plan, identifying warning signs was the most remembered portion. The most useful safety plan elements were: recognizing warning signs, supportive people and distracting social settings, names and numbers of professionals, giving the veteran personal coping strategies, options for using the plan, and keeping their environment safe. For some veterans, safety plans were seen as insufficient, undesirable, not necessary, or lacking a guarantee. The suggested improvements included involving concerned significant others, specific actions to take in a crisis, and potential barriers and alternatives.
Safety planning is a critical component in suicide prevention within VHA. However, future research is needed to ensure safety plans are accessible, implemented, and useful to veterans when in crisis.
本评估考察了安全计划的作用，安全计划是美国退伍军人事务部（VA）通过退伍军人健康管理局（VHA）管理的全国医疗保健设施网络为退伍军人提供的众多临床预防自杀干预措施之一。
对自加入退伍军人事务部医疗保健系统以来经历过自杀意念或自杀未遂的退伍军人（N=29）进行了访谈。主题包括负面生活经历、自杀意念或自杀未遂的触发因素、在危机中回忆和使用安全计划的能力、安全计划中最有用和最无用的元素，以及对安全计划的改进。
在样本中，有 18 名（62.07%）退伍军人有过自杀企图。到目前为止，药物使用是最容易引发自杀的因素，而药物过量是导致随后出现自杀意念或企图的最负面的生活事件。尽管所有高危退伍军人都应该有安全计划，但只有 13 人（44.38%）制定了安全计划，而 15 人（51.72%）无法回忆起曾与他们的提供者制定过安全计划。在那些确实记得制定安全计划的人中，识别警告信号是最容易记住的部分。最有用的安全计划元素包括：识别警告信号、支持性人员和分散注意力的社交环境、专业人员的姓名和号码、给予退伍军人个人应对策略、使用计划的选项，以及保持环境安全。对一些退伍军人来说，安全计划被认为是不够的、不可取的、不必要的或没有保障的。建议的改进措施包括让有关的重要他人参与、在危机中采取具体行动，以及潜在的障碍和替代方案。
安全计划是退伍军人健康管理局预防自杀的一个关键组成部分。然而，未来的研究需要确保安全计划对退伍军人在危机中是可获得、可实施和有用的。
