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Strombotne KL, Li Y, Adams RS, Sadej ID, Garrido MM. Veterans Crisis Line Contacts After the 988 Suicide and Crisis Lifeline Rollout. Am J Prev Med 2024; 67:282-284. [PMID: 38508424 DOI: 10.1016/j.amepre.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION This study identifies changes in Veterans Crisis Line (VCL) contact volume following the 988 National Suicide Prevention Hotline rollout, and examines changes in contact volume for self-identified Veterans. METHODS VCL's Medora database was analyzed from July 2018 to June 2023, fitting linear interrupted time series models to forecast trends after the July 2022 rollout of the 988 Suicide Prevention Hotline. Data analysis was performed from 2023 to 2024. RESULTS After the 988 rollout, average monthly VCL contact volume increased by 5,388 contacts (8.2%). The number of contacts self-identifying as Veterans increased by 2,739 (6.2%), while the percentage of self-identifying Veteran contacts who could be linked to VHA records declined by 3.8%. CONCLUSIONS The 988 rollout was associated with increased VCL contact volume and broad changes in the profile of users. This underscores the importance of crisis services in adapting to dynamic user needs and highlights the potential of national suicide prevention initiatives to reach diverse populations.
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Affiliation(s)
- Kiersten L Strombotne
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts; Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts.
| | - Yufei Li
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts; Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Rachel Sayko Adams
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts; Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts; VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado
| | - Izabela D Sadej
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts; Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Melissa M Garrido
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts; Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts
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Britton PC, Bohnert KM, Denneson LM, Ganoczy D, Ilgen MA. Psychiatric diagnoses, somatic disorders, and emergency dispatches among individuals who used a national suicide crisis line. J Psychiatr Res 2024; 174:114-120. [PMID: 38626561 DOI: 10.1016/j.jpsychires.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/19/2024] [Accepted: 04/09/2024] [Indexed: 04/18/2024]
Abstract
Crisis line responders initiate emergency dispatches by activating 911 or other local emergency services when individuals are determined to be at imminent risk for undesired outcomes. This study examined the association of characteristics, psychiatric diagnoses, and somatic symptoms with emergency dispatches in a national sample. Veterans Crisis Line data were used to identify contacts (i.e., calls, texts, chats, emails) that were linked with medical records and had a medical encounter in the year prior to contact. Hierarchical logistic regression clustered by responders was used to identify the association among demographics, psychiatric diagnoses, and somatic disorders, and emergency dispatches. Analyses examined 247,340 contacts from 2017 to 2020, with 27,005 (10.9%) emergency dispatches. Odds of an emergency dispatch increased with each diagnosis (three diagnoses Adjusted Odds Ratio [AOR] (95% CI) = 1.88 [1.81,1.95]). Odds were highest among individuals with substance use disorders (SUD) (alcohol AOR (95% CI) = 1.85 [1.80,1.91]; drugs AOR (95% CI) = 1.63 [1.58, 1.68]), which may be a result of intoxication or overdose during contact, requiring further research. Having more psychiatric and somatic conditions was associated with greater odds of an emergency dispatch, indicating that comorbidity contributed to the need for acute care.
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Affiliation(s)
- Peter C Britton
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
| | - Kipling M Bohnert
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA; Department of Veteran Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Lauren M Denneson
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Dara Ganoczy
- Department of Veteran Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Mark A Ilgen
- Department of Veteran Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
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Britton PC, Karras E, Stecker T, Klein J, Crasta D, Brenner LA, Pigeon WR. The Veterans Crisis Line: Relations among immediate call outcomes and treatment contact and utilization following the call. Suicide Life Threat Behav 2024. [PMID: 38687175 DOI: 10.1111/sltb.13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Crisis line callers experience reductions in distress and suicidal ideation and utilize more health care following calls. The purpose of this study was to determine whether changes in distress and suicidal ideation during a call are associated with later healthcare contact and utilization. METHOD Veterans Crisis Line calls from 599 veterans were extracted with call dates between 12/1/2018 and 11/30/2019. Calls were coded for changes in distress and suicidal ideation and linked with VA medical records to obtain healthcare data. Generalized Linear Mixed Modeling was used to examine the associations of changes in distress and suicidal ideation with healthcare contact (yes/no) and utilization (days of treatment) in the month (30 days) following the call. RESULTS Reductions in distress were associated with behavioral (i.e., mental and substance use) healthcare utilization, F(1, 596) = 4.52, p = 0.03, and reductions in suicidal ideation were associated with any healthcare utilization, F(1, 596) = 6.45, p = 0.01. Changes in distress and suicidal ideation were not associated with healthcare contact. CONCLUSION Responders need to help resolve distress and suicidal ideation and link callers with treatment. Unresolved distress and suicidal thoughts may signify later problems with treatment utilization. Research is needed to determine causality.
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Affiliation(s)
- Peter C Britton
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Elizabeth Karras
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John Klein
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
| | - Dev Crasta
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Lisa A Brenner
- Rocky Mountain MIRECC for Suicide Prevention, VA Eastern Colorado Health Care System, Denver, Colorado, USA
- Department of Psychiatry, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
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Britton PC, Bohnert KM, Denneson LM, Ganoczy D, Ilgen MA. Reasons for contacting a crisis line and the initiation of emergency dispatches. Prev Med 2024; 181:107899. [PMID: 38373477 DOI: 10.1016/j.ypmed.2024.107899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To better understand processes of mental health crisis line utilization by examining associations between reasons for contacting a crisis line with the initiation of emergency dispatches (i.e., activation of 911 or local emergency services) in a national sample. METHODS Contacts (i.e., calls, texts, email, and chats) to the Veterans Crisis Line (VCL) across 2017-2020 were used to examine associations among stated reasons for the contact and the use of an emergency dispatch. Hierarchical logistic regression models were used to determine the odds of an emergency dispatch by reason for the contact. RESULTS Suicidal thoughts/crisis were present in 61.5% of contacts that ended in emergency dispatches and were associated with the largest adjusted odds of a dispatch, (Adjusted Odds Ratio [AOR] [95% CI] = 9.34 [9.21, 9.48]), followed by homicidal thoughts/crisis (AOR [95% CI] = 3.84 [3.73, 3.95]), and third-party concerns (AOR [95% CI] = 2.42 [2.37, 2.47]). Substance use/ addiction (AOR [95% CI] = 2.14 [2.10, 2.18]), abuse and violence (AOR [95% CI] = 1.89 [1.82, 1.96]), and physical health (AOR [95% CI] = 1.87 [1.84, 1.91]) were also associated with increased odds of a dispatch. CONCLUSIONS Emergency dispatches are primarily used in response to imminent suicide risk but are also used in other potentially violent or lethal circumstances such as homicides, violence or abuse, and other crises. These findings highlight the role that crisis lines play in emergency service delivery, and the need to better understand how they are utilized under real world circumstances.
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Affiliation(s)
- Peter C Britton
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester Medical School, Rochester, NY, USA.
| | - Kipling M Bohnert
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA; Department of Veteran Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Lauren M Denneson
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Dara Ganoczy
- Department of Veteran Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Mark A Ilgen
- Department of Veteran Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
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Reger MA, Legler A, Lauver M, Tenso K, Manchester C, Griffin C, Strombotne KL, Landes SJ, Porter S, Bourgeois JE, Garrido MM. Caring Letters Sent by a Clinician or Peer to At-Risk Veterans: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e248064. [PMID: 38683611 PMCID: PMC11059042 DOI: 10.1001/jamanetworkopen.2024.8064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/25/2024] [Indexed: 05/01/2024] Open
Abstract
Importance Caring letters is an evidence-based suicide prevention intervention in acute care settings, but its outcomes among individuals who contact a national crisis line have not previously been evaluated. Objective To examine the outcomes of the Veterans Crisis Line (VCL) caring letters intervention and determine whether there are differences in outcomes by signatory. Design, Setting, and Participants This parallel randomized clinical trial compared signatories of caring letters and used an observational design to compare no receipt of caring letters with any caring letters receipt. Participants included veterans who contacted the VCL. Enrollment occurred between June 11, 2020, and June 10, 2021, with 1 year of follow-up. Analyses were completed between July 2022 and August 2023. Intervention Veterans were randomized to receive 9 caring letters for 1 year from either a clinician or peer veteran signatory. Main Outcomes and Measures The primary outcome measure was suicide attempt incidence in the 12 months following the index VCL contact. Incidence of Veterans Health Administration (VHA) inpatient, outpatient, and emergency health care use were secondary outcomes. All-cause mortality was an exploratory outcome. Wilcoxon rank-sum tests and χ2 tests were used to assess the differences in outcomes among the treatment and comparison groups. Results A total of 102 709 veterans (86 942 males [84.65%]; 15 737 females [15.32%]; mean [SD] age, 53.82 [17.35] years) contacted the VCL and were randomized. No association was found among signatory and suicide attempts, secondary outcomes, or all-cause mortality. In the analysis of any receipt of caring letters, there was no evidence of an association between caring letters receipt and suicide attempt incidence. Caring letters receipt was associated with increased VHA health care use (any outpatient: hazard ratio [HR], 1.10; 95% CI, 1.08-1.13; outpatient mental health: HR, 1.19; 95% CI, 1.17-1.22; any inpatient: HR, 1.13; 95% CI, 1.08-1.18; inpatient mental health: HR, 1.14; 95% CI, 1.07-1.21). Caring letters receipt was not associated with all-cause mortality. Conclusions and Relevance Among VHA patients who contacted the VCL, caring letters were not associated with suicide attempts, but were associated with a higher probability of health care use. No differences in outcomes were identified by signatory. Trial Registration isrctn.org Identifier: ISRCTN27551361.
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Affiliation(s)
- Mark A. Reger
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Aaron Legler
- Partnered Evidence-Based Policy Resource Center, Veterans Affairs Boston Health Care System, Boston, Massachusetts
| | - MaryGrace Lauver
- Department of Veterans Affairs, Veterans Crisis Line, Office of Mental Health and Suicide Prevention, Veterans Affairs Central Office, Washington, DC
| | - Kertu Tenso
- Partnered Evidence-Based Policy Resource Center, Veterans Affairs Boston Health Care System, Boston, Massachusetts
- Boston University School of Public Health, Boston, Massachusetts
| | | | - Cameron Griffin
- Veterans Affairs Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Ann Arbor, Michigan
| | - Kiersten L. Strombotne
- Partnered Evidence-Based Policy Resource Center, Veterans Affairs Boston Health Care System, Boston, Massachusetts
- Boston University School of Public Health, Boston, Massachusetts
| | - Sara J. Landes
- Center for Mental Health Outcomes and Research, Central Arkansas Veterans Healthcare System, North Little Rock
- South Central Mental Illness Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock
- Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock
| | - Shelan Porter
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Jolie E. Bourgeois
- Department of Veterans Affairs, Veterans Crisis Line, Office of Mental Health and Suicide Prevention, Veterans Affairs Central Office, Washington, DC
| | - Melissa M. Garrido
- Partnered Evidence-Based Policy Resource Center, Veterans Affairs Boston Health Care System, Boston, Massachusetts
- Boston University School of Public Health, Boston, Massachusetts
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Britton PC, Karras E, Stecker T, Klein J, Crasta D, Brenner LA, Pigeon WR. Veterans Crisis Line Call Outcomes: Treatment Contact and Utilization. Am J Prev Med 2023; 64:658-665. [PMID: 36805255 DOI: 10.1016/j.amepre.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 02/19/2023]
Abstract
INTRODUCTION Crisis lines are a central component of suicide prevention strategies in the U.S. and for the Department of Veterans Affairs. The purpose of this study is to evaluate the impact of calling the Veterans Crisis Line on treatment contact and utilization. METHODS Call records from 599 veterans who called in 2019 were linked with medical records and analyzed in 2020. Multilevel generalized linear modeling examined pre-post changes in treatment contact (yes/no) and utilization (number of days of care). RESULTS In the month after the call, 85% of callers made contact with health care, and 79% made contact with behavioral health care. Callers were more likely to make contact with health care in the month after the call than in the preceding month (AOR=6.27, 95% CI=4.22, 9.32) and more likely to make contact with behavioral health care (AOR=10.21, 95% CI=6.66, 15.67). Days of health care nearly doubled to 4.82, and days of behavioral health care more than doubled to 3.52. CONCLUSIONS Among veteran callers who are linked to medical records, calling the Veterans Crisis Line may increase contact and utilization of health care and behavioral health care. These findings support crisis lines that are linked with healthcare systems in public health strategies for suicide prevention.
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Affiliation(s)
- Peter C Britton
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | - Elizabeth Karras
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Tracy Stecker
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York; College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - John Klein
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York
| | - Dev Crasta
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Lisa A Brenner
- Rocky Mountain MIRECC for Suicide Prevention, Denver, Colorado; Department of Psychiatry, School of Medicine, University of Colorado, Denver, Colorado
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua, New York; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
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García-Berná JA, Sobrino-Duque R, Carrillo de Gea JM, Nicolás J, Fernández-Alemán JL. Automated Workflow for Usability Audits in the PHR Realm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158947. [PMID: 35897314 PMCID: PMC9368126 DOI: 10.3390/ijerph19158947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 02/06/2023]
Abstract
Teleworking is an everyday reality in today’s world. Many companies are opting for this way of working remotely, as it improves employers’ satisfaction along with the work–life balance and it does not lead to any significant reduction in performance. In general, the comfortable use of software applications is a priority, and quality aspects such as usability are of vital importance. In this paper, a novel workflow is proposed. It consists of the following components: (1) a tool to manage usability evaluations based on expert reviews, called Usevalia; (2) a set of heuristics to be considered when performing the evaluations; (3) a catalogue of usability requirements to guide the evaluations; (4) a checklist related to the heuristics to verify that the evaluations have been performed correctly by all the auditors; and (5) a set of tasks to know in advance the functionality of the applications to be audited. Personal health records (PHRs) were taken as a case study. This methodology made it possible to involve a total of 31 working groups that evaluated the usability of four PHRs. Concerning the main results, the evaluators agreed that with Usevalia the usability evaluations could go a step further because they are coordinated and can work together remotely. In addition, analyses of usability scores provided insight into current proposals for improving usability of applications.
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