Understanding Impact of VHA's New Suicidal Ideation Screening Initiative: Veteran's Perspective

了解 VHA 新的自杀意念筛查计划的影响：退伍军人的观点

• 批准号: 10084169
• 负责人: Steven K Dobscha
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-12-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10084169
• 关键词: Address; Affect; Afghanistan; Antidepressive Agents; Caring; Cessation of life; Characteristics; Clinical; Collaborations; Data; Detection; Development; Disclosure; Elements; Evaluation; Feeling suicidal; Goals; Health; Health Care Visit; Health Personnel; Healthcare; Individual; Intervention; Interview; Iraq; Knowledge; Letters; Measures; Medical; Medical Care Team; Mental Depression; Mental Health; Mental Health Services; Methodology; Methods; Modeling; Movement; Natural History; Outcome; Pathway interactions; Patient Care Team; Patient Preferences; Patient-Centered Care; Patients; Perception; Pharmaceutical Preparations; Population; Post-Traumatic Stress Disorders; Primary Care; Process; Provider; Recommendation; Reporting; Research; Respondent; Risk; Sampling; Screening Result; Self Direction; Site; Structure; Suicide; Suicide prevention; Surveys; Testing; Therapeutic; Veterans; Veterans Health Administration; Violence; Visit; War; barrier to care; cohort; data warehouse; experience; improved; innovation; medical specialties; member; novel strategies; patient engagement; patient population; patient-clinician communication; population based; primary care team; process evaluation; recruit; reducing suicide; research clinical testing; response; satisfaction; screening; screening program; suicidal risk; systematic review; treatment optimization; treatment planning; tv watching

Background: Population-based screening programs for suicidal ideation (SI) are becoming standard practice. This year, VHA is implementing a new multi-stage SI screening and evaluation process, VA Risk-ID. However, prior research has shown that Veterans often feel uncomfortable disclosing SI during screening, and that Veterans frequently do not disclose SI at healthcare visits proximal to suicide. Further, there is almost nothing known about how SI screening experiences may impact subsequent treatment engagement. Factors known to be associated with treatment engagement include effective patient-clinician communication, therapeutic alliance, and collaborative treatment planning. Negative perceptions of SI screening have the potential to adversely affect Veteran comfort disclosing and discussing SI, as well as subsequent engagement in care. Significance/Impact: Suicide prevention is VHA’s highest priority, and optimizing engagement of at-risk Veterans in treatment is of critical importance. This project addresses key gaps: 1) It will generate knowledge about both positive and potentially negative impacts of a population-based SI screening process; 2) It will generate comprehensive information about SI screening from the perspective of patients; and 3) It will examine the relationship between screening experiences and subsequent engagement in care. Innovation: This project will use a mixed methods approach to characterize the “natural history” of the treatment of Veterans screened for SI in primary care and mental health settings primarily from the perspective of Veterans, from the point of initial depression or PTSD screening until 6 months after screening. Specific Aims: (1) In a national, stratified random sample of Veterans screened in primary care and mental health, using quantitative surveys, characterize Veteran experiences with VA Risk-ID screening and clinical evaluation that takes place in response to screening; (2) Conduct semi-structured qualitative interviews with Veterans and staff who participate in SI screening, with the goal of identifying ways to improve screening and engagement after screening; (3) Among the group of Veterans screened in primary care, examine the extent to which screening process variables are associated with mental health treatment utilization over 6 months. Methodology: This 3-year mixed-methods project will utilize quantitative and qualitative data from a national, stratified random sample of Veterans. In Aim 1, we will mail recruitment letters immediately after VA Risk-ID screening to 2,000 Veterans screened in primary care and 2,000 Veterans screened in specialty mental health who have not received mental health treatment in the prior 12 months. Respondents will be invited to complete surveys including measures assessing satisfaction with screening, patient-care team interactions and perceived barriers to care and disclosure. In Aim 2, informed by Aim 1 survey results, up to approximately 40 Veterans identified from the survey cohorts will participate in semi-structured interviews. We will also interview up to 40 clinical staff members from primary care and mental health settings of three or more VHA facilities. Qualitative analyses will prioritize identification of ways for clinical teams to detect and respond to SI more satisfactorily and effectively. In Aim 3, within the group of Veterans screened in primary care, we will examine the extent to which screening results and survey variables are associated with subsequent engagement in mental health treatment over 6 months. Outcomes will include specialty mental health visits attended (when referred) and antidepressant fills (when recommended by providers). VHA’s Corporate Data Warehouse will provide care utilization data. Multivariable models will adjust for patient and care team and site characteristics. Next Steps/Implementation: This project will inform further development and implementation of VHA’s SI screening processes, and lay groundwork for 1) development and testing of new interventions for primary care and mental health care teams to improve SI screening and care engagement; and 2) additional research examining the impacts of early care experiences of Veterans at risk for suicide on health outcomes.

背景：以人群为基础的自杀意念（SI）筛查项目正在成为标准实践。 今年，VHA正在实施一个新的多阶段SI筛查和评估过程，VA风险ID。然而， 先前的研究表明，退伍军人在筛查期间经常感到不舒服， 退伍军人经常不透露SI在医疗访问接近自杀。此外，几乎没有什么 了解SI筛查经历如何影响后续治疗参与。已知的因素 包括有效的患者-临床医生沟通，治疗 联盟和协作治疗计划。对SI筛查的负面看法有可能 不利地影响退伍军人舒适披露和讨论SI，以及随后的护理参与。 意义/影响：自杀预防是VHA的最高优先事项，并优化风险参与 退伍军人的治疗至关重要。该项目解决了主要差距：1）它将产生知识 关于基于人群的SI筛查过程的积极和潜在负面影响; 2）它将 从患者的角度生成关于SI筛查的全面信息;以及3）它将检查 筛查经验与随后参与护理之间的关系。 创新：该项目将使用混合方法来描述“自然历史”的特征。 在初级保健和精神卫生环境中筛查SI的退伍军人的治疗， 从最初的抑郁症或PTSD筛查开始，直到筛查后6个月。 具体目的：（1）在一个国家，分层随机抽样的退伍军人筛选在初级保健和精神 健康，使用定量调查，描述退伍军人的经验与VA风险ID筛查和临床 （2）进行半结构化的定性访谈， 参加SI筛查的退伍军人和工作人员，目的是确定改善筛查的方法， （3）在初级保健中筛选的退伍军人群体中，检查 哪些筛选过程变量与6个月内的心理健康治疗利用率相关。 方法：这一为期3年的混合方法项目将利用来自国家、 退伍军人的分层随机抽样。在目标1中，我们将在VA Risk-ID之后立即发送招聘信 对2,000名在初级保健中接受筛查的退伍军人和2,000名在专业精神健康中接受筛查的退伍军人进行筛查 在过去12个月内没有接受过心理健康治疗。受访者将被邀请填写 调查，包括评估筛查满意度的措施，病人护理团队的互动， 在关心和披露方面的障碍。在目标2中，根据目标1的调查结果， 从调查队列中确定的退伍军人将参加半结构化访谈。我们还将采访 来自三个或更多VHA设施的初级保健和心理健康环境的最多40名临床工作人员。 定性分析将优先确定临床团队检测和应对SI的方法。 令人满意和有效。在目标3中，在初级保健中筛选的退伍军人群体中，我们将研究 筛选结果和调查变量与后续参与的相关程度 6个月以上的心理健康治疗。结果将包括参加的专业心理健康访视（当 推荐）和抗抑郁剂填充（当提供者推荐时）。VHA的企业数据仓库将 提供护理使用数据。多变量模型将根据患者和护理团队以及临床试验机构的特征进行调整。 后续步骤/实施：该项目将为VHA SI的进一步开发和实施提供信息 筛选过程，并为1）制定和测试新的初级保健干预措施奠定基础 和精神卫生保健团队，以改善SI筛查和护理参与;和2）额外的研究 研究有自杀风险的退伍军人的早期护理经历对健康结果的影响。

项目成果

Primary Care and Mental Health Staff Perspectives on Universal Suicide Risk Screening and Care Coordination.

初级保健和心理健康工作人员对普遍自杀风险筛查和护理协调的看法。

• DOI: 10.1176/appi.ps.20220087
• 发表时间: 2023
• 期刊: Psychiatric services (Washington, D.C.)
• 作者: Dobscha,StevenK;Newell,SummerB;Elliott,VictoriaJ;Rynerson,AnnabelleL;Rabin,Sarah;Bahraini,Nazanin;Post,EdwardP;Denneson,LaurenM
• 通讯作者: Denneson,LaurenM

Veterans Health Administration staff experiences with suicidal ideation screening and risk assessment in the context of COVID-19.

• DOI: 10.1371/journal.pone.0261921
• 发表时间: 2021
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Newell S;Denneson L;Rynerson A;Rabin S;Elliott V;Bahraini N;Post EP;Dobscha SK
• 通讯作者: Dobscha SK

Veteran Perspectives on Population-Based Suicide Risk Screening in VHA Primary Care: Mixed-Methods Study.

退伍军人对 VHA 初级保健中基于人群的自杀风险筛查的看法：混合方法研究。

• DOI: 10.1007/s11606-023-08148-w
• 发表时间: 2023
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Denneson,LaurenM;Newell,Summer;Elliott,Victoria;Rynerson,Annabelle;Niederhausen,Meike;Salvi,Apoorva;Handley,Robert;Bahraini,Nazanin;Post,EdwardP;Carlson,KathleenF;Dobscha,StevenK
• 通讯作者: Dobscha,StevenK