Warning signs for suicide within a week of healthcare contact in Veteran decedents

Abstract

Objectives-This study examined warning signs for suicide observed in the final day(s) of life in Veteran decedents who received healthcare from Veterans Health Administration (VHA) (N=381), using data obtained from detailed chart reviews.Methods-Veterans who died within a week (7 days) of healthcare contact (18%) were compared to those who died later (82%). Multivariate logistic regression was used to examine differences in suicidal thoughts, psychiatric symptoms, and somatic symptoms as documented at the last visit, after controlling for demographic variables. A second multivariate regression examined whether the identified warning signs were also risk factors for suicide within a month (30 days) of contact.Results-Documented suicidal ideation, OR (95% CI) = 3.46 (1.15-10.38), and psychotic symptoms, OR (95% CI) = 2.67 (1.11-6.42), at the last visit increased the likelihood of suicide within a week of healthcare contact. Both variables also increased the odds of suicide within a month of contact.Conclusions-The assessment of suicidal ideation is critical to identifying Veterans at immediate risk. However, recognition of psychotic symptoms may also improve identification. In addition to indicating immediate risk, some warning signs may also suggest on-going risk.

Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: A meta-analytic review

“…For example, according to Beck's cognitive model of suicide, once a suicide schema is activated, anxiety (and agitation) can serve as an expression of attentional fixation on suicide, which interacts with hopelessness to increase suicide risk (e.g., Wenzel & Beck, 2008; Wenzel, Brown, & Beck, in press). Although anxiety is not explicitly addressed in Joiner's interpersonal theory of suicide (Joiner, 2005; Van Orden et al, 2010), this model's emphasis on the fearsome nature of suicidal behavior is consistent with evidence showing that acute anxious states (e.g., heightened arousal/agitation, severe panic attacks) are often present immediately prior to lethal or near-lethal suicidal acts (e.g., Britton, Ilgen, Rudd, & Conner, 2012; Busch, Fawcett, & Jacobs, 2003; Conrad et al, 2009; Fawcett et al, 1990; Hall, Platt, & Hall, 1999; Ribeiro et al, 2015; Ribeiro, Silva, & Joiner, 2014). These findings align with Fawcett's influential conceptualizations of anxiety/agitation as a determinant for acute suicide risk (e.g., Fawcett, 2001; Fawcett, Busch, Jacobs, Kravitz, & Fogg, 1997), and expert clinical consensus identifying agitation as a “warning sign” for suicide (e.g., Rudd et al, 2006).…”

Signs of current suicidality in men: A systematic review

“…The timeframe is particularly important as research into suicide signs has often not taken timeframe into account [22]. Because of the difficulty associated with assessing signs of suicide in the minutes or hours prior to death [9], the ‘near term’ timeframe for this study was extended to 4 weeks.…”

Correlates of Suicide Among Veterans Treated in Primary Care: Case–Control Study of a Nationally Representative Sample

“…We used a systematic, iterative process to develop a medical record data collection tool to record documentation of previously identified suicide risk factor variables in the 6 months prior to the index date; we have used similar approaches in prior studies. 9,[20][21][22][23][24] Clinical variables determined using this method included sleep problems, functional decline, anger, and suicidal ideation endorsement; psychosocial context variables included housing instability, isolation, grief/loss of a loved one, recent move, and financial, legal, job/school, or relationship problems (Table 2). These items were selected based on prior research suggesting possible relationships among these variables and suicide risk, and recommended data elements from the Centers for Disease Control and Prevention.…”

“…These items were selected based on prior research suggesting possible relationships among these variables and suicide risk, and recommended data elements from the Centers for Disease Control and Prevention. 9,15,20,22,[24][25][26][27] The majority of these variables were recorded dichotomously-counted as "yes" if the construct was documented in any progress note by clinicians or other medical staff (e.g., medical assistants or nurses) during the 6 months prior to the index date. For suicidal ideation and attempts, there were three levels: not asked (suicidal ideation not mentioned in notes); not endorsed (veteran asked, but did not endorse); and endorsed (veteran asked and endorsed).…”