Suicide rates in the VA healthcare system are higher than in the general population, and they are increasing. VA patients may be at increased risk as a result of the high prevalence of many well known risk factors. Chronic pain is an additional risk factor for suicide, but research on this association among Veterans is lacking. This pilot project will inform the development of a Merit Review application to perform an in-depth patient level study of potentially modifiable risk and protective factors for suicide and suicide attempts highly prevalent among Veterans, in particular, chronic pain. However, before that can be undertaken, pilot work must define and validate information that can be gathered from VA data which may be used to constitute the sample of Veterans at risk for suicide or suicide attempts.
The aims of this pilot project are to: 1. Abstract data from electronic medical records to ascertain the completeness and determination of the provider's evaluation of suicide risk in a sample of Veterans who screen positive for depression during a VA primary care visit 2. Determine the agreement between the providers evaluation of suicide risk and the suicide risk assessment from the data entered into the Health Factors file 3. Examine the correlates of discrepant findings of suicide risk, including patient demographics and pain assessment as well as severity of pain Design This study will develop and conduct a structured retrospective chart review to determine the provider's evaluation of suicide risk among Veterans who screen positive for depression. We will select and review the charts of 300 Veterans who screen positive for depression on at least one primary care visit at the VACHS West Haven campus during the period 1 October 2008 until 31 September 2009. We will then compare results from the provider's evaluation of suicide risk to Health Factors based assessment results. We will then examine correlates of discrepant findings (e.g. assessment is positive for risk but clinician evaluates the patient as negative), including patient demographics and pain scores. Integration of Pilot Study with Larger Study Because 'suicide prevention programs depend on the accuracy with which assessments of suicidality are conducted', a review of the completeness and discrepancies in the suicide risk screening is crucial. Given that the VA uses a 'single, integrated electronic medical record (EMR) system for all of its clinical activities', this can be assessed. The preliminary work of this pilot project will be the basis of a Merit Review application to be conducted in collaboration with members of the Canandaigua VA Medical Center Mental Health Center of Excellence which focuses on suicide prevention. We plan to constitute a multi-site cohort study of Veterans with suicide risk in order to examine the longitudinal course of pain and its likely substantial effect on suicidal risk and attempts. Ultimately, we will determine whether high prevalence conditions among Veterans in care, such as chronic pain and pain conditions, can be used to more effectively target suicide and suicide attempts prevention and intervention efforts.
Significance: Inaccurate suicide risk screening may result in many 'false positives', leading to an overestimation of the risk among Veterans in care, or more catastrophically, to 'false negatives', wherein a Veteran at risk is not detected or treated. This project and the studies to result from our findings represent a unique opportunity to examine the accuracy and completeness of the results of our suicide risk screening, and to compare those results to an in-depth examination of the Veterans EMR data to more clearly elucidate which Veterans are at risk, and to determine whether conditions that are peculiar to Veterans in care, such as the high prevalence of chronic pain and pain conditions, can be used to more effectively target suicide and suicide attempts prevention and intervention efforts.
