Suicide risk factors among veterans: Risk management in the changing culture of the department of veterans affairs

Abstract

Suicide risk management in the Department of Veterans Affairs (VA) health care system is particularly challenging because of both patient characteristics and aspects of the delivery system. The prototypical suicide-prone person is an older white male with alcoholism, depression, physical problems, and poor psychosocial support. This describes a large portion of the veteran patient population. Suicide risk factors that are common in VA patients include male gender, older age, diminished social environment support (exemplified by homelessness and unmarried status), availability and knowledge of firearms, and the prevalence of medical and psychiatric conditions associated with suicide. A variety of characteristics of the VA system complicate suicide management. Efforts under way to emphasize ambulatory care and decrease the VA culture of reliance on inpatient treatment heighten the importance of accurate suicide assessment. The authors recommend several strategies that VA administrators can consider for improving the assessment and management of veterans with long-term suicide risk factors.

Suicide Mortality Among Patients Treated by the Veterans Health Administration From 2000 to 2007

“…These concerns are largely driven by recent findings documenting an elevated prevalence of suicide risk factors among individuals who served in Iraq or Afghanistan. 4,5 However, suicide has multiple causal pathways that are influenced by a variety of components, such as biological (e.g., gender), socioeconomic (e.g., employment status), and other factors (e.g., access to firearms) and confer increased risk of suicidal behaviors and suicide among specific cohorts. 2,15,16,31 Mental health problems associated with these recent conflicts may not directly lead to increased rates of suicide among VHA users.…”

“…VHA patients are more likely to have characteristics related to higher risk of suicide, including older age, male gender, and substantial medical and psychiatric morbidities. 4,5 Recent studies provide inconsistent information regarding the relative risk of suicide in veterans. Kaplan et al 6 found that male veterans who responded to the US National Health Interview Survey were twice as likely to report a suicide attempt as nonveteran males.…”

What precipitates deliberate self-harm?

“…Older patients were much more likely to have both a serious depressive illness and concomitant physical illness. Chronic illness and/ or pain are well-recognised risk factors for self-harm and suicide (Cassem 1991;Johanssen et al 1997), and are of particular importance in the elderly (Dennis & Lindesay 1995;Conwell 1997;Grabbe et al 1997;Lambert & Fowler 1997).…”

Linking mental health and addiction services: A continuity-of-care team model

“…2'3 In addition, the organizational structure had developed along discipline lines, so that interdisciplinary team functioning involved complicated interactions between the different clinicians and services. 4 This article describes an extensive reorganization of the mental health care services at a large VA medical center motivated by the desire to improve access to care and continuity of treatment for a predominantly dually diagnosed veteran patient population. The reorganization, eventually approached as a quality improvement activity, brought together practitioners of mental health disciplines (nurses, psychologists, psychiatrists, and social workers) under one functional organization called mental health.…”