Can services to address Veterans social determinants of health reduce their suicide risk?

背景：尽管退伍军人健康中心提供了可获得和有效的自杀预防策略 根据美国政府(VHA)的调查，退伍军人自杀率仍高于美国总人口，这表明 继续需要确定有自杀风险的退伍军人，并提供预防自杀的干预措施。自杀 当卫生保健系统整合动态的健康社会决定因素(SDH)时，可以加强预防， 比如住房不稳定、司法介入和失业。 意义/影响：这个高铁和研发老兵自杀预防项目的目标是解决预防问题 通过检查解决SDH的服务如何也可以防止 退伍军人，退伍军人管理局2018-2028年防止退伍军人自杀国家战略的关键目标。 创新：这项研究将通过SDH的镜头将公共卫生视角整合到自杀预防中。 这项研究不是专门关注医疗干预，而是探索-基于自然的 利用现有管理数据和收集关键信息者的观点进行实验设计 和退伍军人-考虑到以下方面的复杂需求，解决SDH如何降低自杀风险 可能有自杀风险的退伍军人。 具体目标：这项研究旨在确定为解决SDH而定制的VHA服务是否也可能具有 预防自杀死亡率的额外好处；确定组织资产和机会，以改进 以SDH为重点的服务解决退伍军人中的自杀风险；并让退伍军人参与确定 将自杀预防纳入响应SDH的VHA计划。 方法论：所提出的研究是一种并行混合方法设计。回溯性量化 分析将检查VHA服务如何适应退伍军人的SDH(即住房不稳定、正义 参与、失业)可以预防自杀死亡率和发病率。一种混合的方法 环境扫描将包括对工作人员/主要线人的问卷调查和定性访谈。定性的 对有自杀风险史的退伍军人的采访将探索解决SDH的服务如何应对 这些需求。 执行/下一步：该项目将导致可行的执行项目：加强联系 在有自杀危机史的退伍军人中提供SDH服务，并加强对提供者的培训 将自杀预防与SDH服务相结合，反之亦然。我们召集了一系列 退伍军人事务部运营伙伴-社会工作、退伍军人管理局无家可归者和司法计划、就业计划和退伍军人事务部 心理健康和自杀预防办公室-促进消除SDH和自杀周围的孤岛 预防退伍军人管理局，扩大退伍军人管理局现有的基础设施，以支持自杀预防。

Background: Despite accessible and effective suicide prevention strategies offered by the Veterans Health Administration (VHA), Veteran suicide remains elevated compared to the general US population, indicating a continued need to identify Veterans at risk for suicide and provide interventions to prevent suicide. Suicide prevention can be enhanced when health care systems integrate dynamic social determinants of health (SDH), such as housing instability, justice involvement, and unemployment. Significance/Impact: The goal of this HSR&D Veteran Suicide Prevention project is to address prevention activities that occur “upstream” by examining how services addressing SDH may also prevent suicide among Veterans, key objectives in the VA’s National Strategy for Preventing Veteran Suicide 2018–2028. Innovation: This study will integrate a public health perspective to suicide prevention through a lens of SDH. Rather than focusing specifically on medical intervention, this study will explore—based both on a natural experimental design using existing administrative data and on gathering the perspectives of key informants and Veterans—how addressing SDH can decrease suicide risk, taking into account the complex needs of Veterans who may be at risk for suicide. Specific Aims: This study aims to determine whether VHA services tailored to address SDH may also have an added benefit of preventing suicide mortality; identify organizational assets and opportunities to improve how SDH-focused services address suicide risk among Veterans; and engage Veterans in identifying ways to integrate suicide prevention into VHA programs that respond to SDH. Methodology: The proposed research is a concurrent mixed methods design. Retrospective quantitative analyses will examine how VHA services tailored to Veterans’ SDH (i.e., housing instability, justice involvement, unemployment) may protect against suicide mortality and morbidity. A mixed methods environmental scan will include a questionnaire of staff/key informants and qualitative interviews. Qualitative interviews with Veterans with a history of suicide risk will explore how services to address SDH respond to those needs. Implementation/Next Steps: This project will lead to actionable implementation projects: increased linkages to services for SDH among Veterans with histories of suicidal crisis as well as enhanced training for providers to integrate suicide prevention into services addressing SDH, and vice versa. We have convened an array of VA operations partners—Social Work, VHA Homeless and Justice Programs, employment programs, and VA Office of Mental Health and Suicide Prevention—to facilitate removing siloes around SDH and suicide prevention in VA, amplifying VA’s current infrastructure to bolster suicide prevention.