Assessment of Rates of Suicide Risk Screening and Prevalence of Positive Screening Results Among US Veterans After Implementation of the Veterans Affairs Suicide Risk Identification Strategy.
Assessment of Rates of Suicide Risk Screening and Prevalence of Positive Screening Results Among US Veterans After Implementation of the Veterans Affairs Suicide Risk Identification Strategy.
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DOI：
10.1001/jamanetworkopen.2020.22531
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发表时间：
2020-10-01
影响因子：
13.8
通讯作者：
Matarazzo BB
中科院分区：
文献类型：
--
作者：
Bahraini N;Brenner LA;Barry C;Hostetter T;Keusch J;Post EP;Kessler C;Smith C;Matarazzo BB
在退伍军人健康管理局的医疗环境中，人群水平的自杀风险筛查和评估是否可行，他们是否识别出有自杀风险的患者？在这项对2019财政年度在门诊护理和急诊科环境中筛查的400多万美国退伍军人的横断面研究中，自杀意念的患病率为3.5%。在急诊科筛查的患者自杀风险高于在门诊护理的患者。在退伍军人健康管理局的医疗环境中进行基于人群的自杀风险筛查和评估可能有助于识别那些可能没有接受精神健康治疗的人的风险。2018年，退伍军人健康管理局（VHA）实施了退伍军人事务部（VA）自杀风险识别战略，以改善接受VHA护理的退伍军人自杀风险的识别和管理。研究在门诊护理和急诊科（ED）或急诊诊所（UCC）的退伍军人中自杀筛查阳性结果的患病率，并比较在这些环境中筛查的患者自杀风险的严重程度。这项横断面研究使用来自VA企业数据仓库（CDW）的数据，评估了2018年10月1日至2019年9月30日在140个VHA医疗中心至少进行过1次门诊护理访视（n = 4 101 685）或艾德或UCC访视（n = 1 044 056）的退伍军人。标准化的自杀风险筛查和评估工具。自杀风险筛查和评估的一年率，积极的初级和次级自杀风险筛查结果的患病率，以及基于VHA综合自杀风险评估的急性和慢性风险水平。共有4 101 685名退伍军人在门诊护理机构（平均[SD]年龄，62.3 [16.4]岁; 3 771 379 [91.9%]男性; 2 996 974 [73.1%]白色）和1 044 056名艾德或UCC环境中的退伍军人（平均[SD]年龄，59.2 [16.2]岁; 932 319 [89.3%]男性; 688 559 [66.0%]白色）接受了初步自杀筛查。在门诊护理中，自杀筛查结果阳性的发生率为3.5%（初次筛查）和0.4%（二次筛查），在艾德和UCC中为3.6%（初次筛查）和2.1%（二次筛查）。与在门诊护理中筛查的退伍军人相比，在艾德或UCC中筛查的退伍军人更有可能支持有意图的自杀意念（比值比[OR]，4.55; 95% CI，4.37-4.74; P < .001），具体计划（OR，3.16; 95%CI，3.04-3.29; P < .001）和二次筛选期间的近期自杀行为（OR，1.95; 95%CI，1.87-2.03; P < .001）。在接受综合自杀风险评估的患者中，在艾德或UCC环境中的患者比在门诊护理环境中的患者更有可能处于高急性风险（34.1% vs 8.5%; P <0.001）。在这项横断面研究中，在VHA门诊护理和艾德或UCC环境中进行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。在艾德或UCC环境中的退伍军人与在门诊护理环境中的退伍军人相比，风险更高的敏感度突出了在艾德或UCC中扩大实施简短循证干预以减少自杀行为的重要性。这项横断面研究探讨了在门诊护理和急诊科或紧急护理诊所的退伍军人中自杀筛查结果阳性的患病率，并比较了在这些环境中筛查的患者自杀风险的严重程度。
Are population-level suicide risk screening and evaluation feasible in Veterans Health Administration medical settings and do they identify patients at risk for suicide? In this cross-sectional study of more than 4 million US veterans screened in ambulatory care and emergency department settings during fiscal year 2019, the prevalence of suicidal ideation was 3.5%. Acuity of suicide risk was greater among patients screened in the emergency department than in ambulatory care. Population-based suicide risk screening and evaluation in Veterans Health Administration medical settings may facilitate identification of risk among those who may not be receiving mental health treatment. 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. 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. This cross-sectional study examines the prevalence of positive suicide screening results among veterans in ambulatory care and emergency departments or urgent care clinics and compare acuity of suicide risk among patients screened in these settings.
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影响因子：
120.7
作者：
Kessler, RC;Berglund, P;Wang, PS
通讯作者：
Wang, PS
影响因子：
5.3
作者：
Mundt, James C.;Greist, John H.;Posner, Kelly
通讯作者：
Posner, Kelly
影响因子：
1.9
作者：
Wortzel, Hal S.;Homaifar, Beeta;Brenner, Lisa A.
通讯作者：
Brenner, Lisa A.
DOI：
10.1176/appi.ps.201200587
发表时间：
2013-12-01
期刊：
Psychiatric services (Washington, D.C.)
影响因子：
--
作者：
Simon GE;Rutter CM;Peterson D;Oliver M;Whiteside U;Operskalski B;Ludman EJ
通讯作者：
Ludman EJ
DOI：
10.1176/appi.ajp.2011.10111704
发表时间：
2011-12
期刊：
The American journal of psychiatry
影响因子：
--
作者：
Posner K;Brown GK;Stanley B;Brent DA;Yershova KV;Oquendo MA;Currier GW;Melvin GA;Greenhill L;Shen S;Mann JJ
通讯作者：
Mann JJ