Incidence and antecedents of emergent suicidal ideation and behavior among Veterans with serious mental illness receiving intensive case management.

Veterans with serious mental illness (SMI; i.e., schizophrenia-spectrum disorders, major mood disorders, post-traumatic stress disorder) are a high-risk group for suicide and little is known about those with emergent suicidal ideation and/or behavior. The primary study aim was to examine the six-month incidence and baseline antecedents of emergent suicidal ideation and/or behavior (suicidal ideation and/or behavior at six-month follow-up but not at enrollment) in Veterans with SMI enrolled in the Veterans Health Administration's (VHA) community-based treatment program (i.e., Intensive Community Mental Health Recovery [ICMHR]). A second, exploratory aim was to examine six-month follow-up ICMHR service use (e.g., frequency of contact with Veteran, type of services provided) in those with emergent suicidal ideation and/or behavior. National ICMHR program evaluation data from 2000 to 2013 were analyzed for Veterans with enrollment and six-month follow-up assessments (n = 9921). Analyses examined differences in baseline characteristics and ICMHR service use in those with emergent suicidal ideation and/or behavior compared to those with other suicidal ideation and/or behavior patterns (i.e., none [at either timepoint], improved [present at enrollment but not at follow-up], persistent [present at both timepoints]). Results showed that 1.7% (n = 167) of the sample had emergent suicidal ideation and/or behavior. Some suicidal ideation and/or behavior groups differed significantly from the emergent suicidal ideation and/or behavior group on odds of: lifetime hospitalizations, baseline subjective distress, affective disorder diagnosis, and baseline quality of life. Overall, historical and current clinical factors and quality of life should be assessed in this population given their association with emergent suicidal ideation and/or behavior.