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Tucker BC, Gonzalez VM. Effect of enhanced informed consent on veteran hesitancy to disclose suicidal ideation and related risk factors. Suicide Life Threat Behav 2024; 54:405-415. [PMID: 38345128 DOI: 10.1111/sltb.13053] [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: 07/17/2023] [Revised: 11/17/2023] [Accepted: 01/04/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION The concealment of suicidal ideation (SI) constitutes a significant barrier to reducing veteran deaths by suicide and is associated with fear of negative consequences (e.g., involuntary hospitalization). This study examined whether augmenting informed consent with psychoeducation aimed to help patients achieve a more realistic risk appraisal of consequences associated with disclosure of SI, decreased hesitancy to disclose SI, and related risk behaviors among U.S. veterans. METHOD Participants (N = 133) were recruited from combat veteran social media groups and were randomly assigned to a video simulated treatment-as-usual informed consent (control) or to one of two psychoeducation-enhanced informed consent conditions (psychoed, psychoed + trust). RESULTS Compared with the control group, participants in both psychoeducation and enhanced informed consent conditions reported lower hesitancy to disclose SI, firearm access, and problems with drugs/thoughts of harming others, as well as greater trust and respect for the simulated clinician. CONCLUSIONS These findings suggest that brief psychoeducation regarding common factors that affect hesitancy to disclose SI may be beneficial for increasing trust in providers during the informed consent process and decreasing concealment of SI and firearm access among veterans.
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Affiliation(s)
- Brock C Tucker
- Department of Psychology, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Vivian M Gonzalez
- Department of Psychology, University of Alaska Anchorage, Anchorage, Alaska, USA
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2
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Beydoun HA, Tsai J. Lifetime prevalence and correlates of colorectal cancer screening among low-income U.S. Veterans. Cancer Causes Control 2024:10.1007/s10552-024-01881-5. [PMID: 38714606 DOI: 10.1007/s10552-024-01881-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 04/10/2024] [Indexed: 05/10/2024]
Abstract
PURPOSE The Veterans Health Administration (VHA) is the largest integrated healthcare system in the U.S. While preventive healthcare services are high priority in the VHA, low-income U.S. Veterans experience adverse life circumstances that may negatively impact their access to these services. This study examined lifetime prevalence as well as demographic, socioeconomic, military-specific, and clinical correlates of colorectal cancer (CRC) screening among low-income U.S. Veterans ≥ 50 years of age. METHODS Cross-sectional data on 862 participants were analyzed from the 2021-2022 National Veteran Homeless and Other Poverty Experiences study. RESULTS Overall, 55.3% (95% confidence interval [CI] 51.3-59.3%) reported ever-receiving CRC-screening services. In a multivariable logistic regression model, never-receivers of CRC screening were twice as likely to reside outside of the Northeast, and more likely to be married (odds ratio [OR] = 1.86, 95% CI 1.02, 3.37), have BMI < 25 kg/m2 [vs. 25- < 30 kg/m2] (OR = 1.75, 95% CI 1.19, 2.58), or ≥ 1 chronic condition (OR = 1.46, 95% CI 1.06, 2.02). Never-receivers of CRC screening were less likely to be female (OR = 0.53, 95% CI 0.29, 0.96), aged 65-79y [vs. ≥ 80y] (OR = 0.61, 95% CI 0.40, 0.92), live in 5 + member households (OR = 0.33, 95% CI 0.13, 0.86), disabled (OR = 0.45, 0.22, 0.92), with purchased health insurance (OR = 0.56, 95% CI 0.33, 0.98), or report alcohol-use disorder (OR = 0.10, 95% CI 0.02, 0.49) and/or HIV/AIDS (OR = 0.28, 95% CI 0.12, 0.68). CONCLUSION Nearly 55% of low-income U.S. Veterans reported ever screening for CRC. Variations in CRC-screening behaviors according to veteran characteristics highlight potential disparities as well as opportunities for targeted behavioral interventions.
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Affiliation(s)
- Hind A Beydoun
- National Center on Homelessness Among Veterans (NCHAV), Veterans Health Administration, 810 Vermont Avenue, NW, Washington, DC, 20420, USA.
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Jack Tsai
- National Center on Homelessness Among Veterans (NCHAV), Veterans Health Administration, 810 Vermont Avenue, NW, Washington, DC, 20420, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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3
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Teo AR, Hooker ER, Call AA, Dobscha SK, Gamble S, Cross WF, Rodgers C. Brief video training for suicide prevention in veterans: A randomized controlled trial of VA S.A.V.E. Suicide Life Threat Behav 2024; 54:154-166. [PMID: 38095049 PMCID: PMC11164032 DOI: 10.1111/sltb.13028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 02/15/2024]
Abstract
INTRODUCTION VA S.A.V.E. (Signs; Ask; Validate; Encourage/Expedite) is a gatekeeper training developed by the Department of Veterans Affairs (VA) that teaches individuals to identify and assist veterans at risk for suicide. Although VA S.A.V.E. has been widely disseminated, rigorous evaluation is lacking. METHODS In a pilot randomized controlled trial of a brief, video-based version of VA S.A.V.E., individuals were recruited through Facebook, randomized to VA S.A.V.E. versus an attention control condition, and completed 6-month follow-up. A subgroup (n = 15) completed interviews. We used a mixed methods framework to integrate quantitative and qualitative findings. RESULTS Among 214 participants, 61% were spouses/partners of veterans and 77% had prior suicide exposure. Sixty-seven percent (n = 68) of VA S.A.V.E. participants watched the entire video, and satisfaction and usability were highly rated. At 6-month follow-up, compared to the control group, the VA S.A.V.E. group had a higher proportion of participants use each gatekeeper behavior (66.7%-84.9% vs. 44.4%-77.1%), and used significantly more total gatekeeper behaviors (2.3 ± 0.9 vs. 1.8 ± 1.0; p = 0.01). Interviews supported positive reactions, learning, and behavior change from VA S.A.V.E. CONCLUSION VA S.A.V.E. merits further investigation into its effectiveness as a brief, scalable gatekeeper training for suicide prevention in veterans.
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Affiliation(s)
- Alan R. Teo
- Health Services Research and Development Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon, USA
| | - Elizabeth R. Hooker
- Health Services Research and Development Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA
| | - Aaron A. Call
- Health Services Research and Development Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA
| | - Steven K. Dobscha
- Health Services Research and Development Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon, USA
| | - Stephanie Gamble
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
- VISN2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
| | - Wendi F. Cross
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Carie Rodgers
- Department of Psychiatry, University of California, San Diego, California, USA
- PsychArmor Institute, San Diego, California, USA
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4
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Hoopsick RA, Yockey RA. A national examination of suicidal ideation, planning, and attempts among United States adults: Differences by military veteran status, 2008-2019. J Psychiatr Res 2023; 165:34-40. [PMID: 37459776 DOI: 10.1016/j.jpsychires.2023.07.009] [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: 03/08/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 09/03/2023]
Abstract
There is a widening disparity in suicide deaths between United States (U.S.) military veterans and nonveterans. However, it is unclear if there are similar differences in suicidal ideation, planning, and attempts that often precipitate these deaths. A better understanding of trends in suicidal thoughts and behaviors could illuminate opportunities for prevention. We examined pooled cross-sectional data (N = 479,801 adults) from the 2008 to 2019 National Survey on Drug Use and Health. We examined differences in past-year suicidal ideation, suicide planning, and suicide attempts between U.S. veterans (n = 26,508) and nonveterans (n = 453,293). We conducted post hoc analyses to examine for differences in these relationships by race/ethnicity and sex. Lastly, we examined trends in these outcomes over time and tested for differences in trends by veteran status. Overall, veterans had significantly greater odds of past-year suicidal ideation (aOR = 1.33, 95% CI 1.20 to 1.47) and suicide planning (aOR = 1.52, 95% CI 1.30 to 1.78) compared to nonveterans. However, the association between veteran status and past-year suicide attempt was not statistically significant (aOR = 1.29, 95% CI 1.00 to 1.68). These relationships did not differ by race/ethnicity or sex (ps > 0.05). Among all adults, there were significant linear increases in past-year suicidal ideation, planning, and attempts (ps < 0.001). However, these trends did not differ between veterans and nonveterans (ps > 0.05). Veterans may be more likely to experience suicidal thoughts and behaviors than nonveteran adults. Upward trends in suicidal thoughts and behaviors among both veterans and nonveterans from 2008 to 2019 highlight opportunities for intervention.
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Affiliation(s)
- Rachel A Hoopsick
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, 1206 S. Fourth St., 2017 Khan Annex, Huff Hall, Champaign, IL, 61820, USA.
| | - R Andrew Yockey
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, School of Public Health, 709C, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
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Bossarte RM, Ahuja M, Martik M, Schinelli A, Webb TD, Marx BP. Reconsidering the Existing Paradigm for Suicide Prevention Among Older Adult Veterans and Other Americans. Am J Geriatr Psychiatry 2023; 31:540-542. [PMID: 36958980 DOI: 10.1016/j.jagp.2023.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 03/25/2023]
Affiliation(s)
- Robert M Bossarte
- Department of Psychiatry and Behavioral Neuroscience (RMB, MM), University of South Florida, Tampa, FL.
| | - Manik Ahuja
- Department of Epidemiology (MA), East Tennessee State University, Johnson City, TN
| | - Maria Martik
- Department of Psychiatry and Behavioral Neuroscience (RMB, MM), University of South Florida, Tampa, FL
| | - Anthony Schinelli
- Morsani College of Medicine (AS), University of South Florida, Tampa, FL
| | - Tyler D Webb
- Center of Excellence for Suicide Prevention (TW), Canandaigua VA Medical Center, Canandaigua, NY
| | - Brian P Marx
- National Center for PTSD at VA Boston Healthcare System (BM), Boston VA Medical Center, Boston, MA; Boston University Chobanian and Avedisian School of Medicine
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Knapp S. Lethal Means Counseling for Suicidal Firearm Owners. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2023:1-9. [PMID: 37363717 PMCID: PMC10251328 DOI: 10.1007/s10879-023-09588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/28/2023]
Abstract
The death of a patient by suicide is one of the professional events most feared by psychotherapists and firearms are the most commonly used means of suicide. However, as the number of firearm owners within the United States has increased in recent years, so has the risk of firearm-related suicides. Suicidal patients with easy access to their firearms may give in to the wish to die and end their life with little opportunity for reflection or forethought. Furthermore, because the topic of gun control has become so polarized, patients may not always be open to discussing barriers between themselves and their firearms. Nonetheless, psychotherapists using non-judgmental, respectful, and collaborative lethal means counseling can substantially reduce patient suicides.
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Dent KR, Szymanski BR, Kelley MJ, Katz IR, McCarthy JF. Suicide risk following a new cancer diagnosis among Veterans in Veterans Health Administration care. Cancer Med 2022; 12:3520-3531. [PMID: 36029038 PMCID: PMC9939100 DOI: 10.1002/cam4.5146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/29/2022] [Accepted: 07/28/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Cancer diagnoses are associated with an increased risk for suicide. The aim of this study was to evaluate this association among Veterans receiving Veterans Health Administration (VHA) care, a population that has an especially high suicide risk. METHODS Among 4,926,373 Veterans with VHA use in 2011 and in 2012 or 2013, and without VHA cancer diagnoses in 2011, we assessed suicide risk following incident cancer diagnoses. Risk time was from initial VHA use in 2012-2013 to 12/31/2018 or death, whichever came first. Cox proportional hazards regression models evaluated associations between new cancer diagnoses and suicide risk, adjusting for age, sex, VHA regional network, and mental health comorbidities. Suicide rates were calculated among Veterans with new cancer diagnoses through 84 months following diagnosis. RESULTS A new cancer diagnosis corresponded to a 47% higher suicide risk (Adjusted Hazard Ratio [aHR] = 1.47, 95% CI: 1.33-1.63). The cancer subtype associated with the highest suicide risk was esophageal cancer (aHR = 6.01, 95% CI: 3.73-9.68), and other significant subtypes included head and neck (aHR = 3.55, 95% CI: 2.74-4.62) and lung cancer (aHR = 2.35, 95% CI: 1.85-3.00). Cancer stages 3 (aHR = 2.36, 95% CI: 1.80-3.11) and 4 (aHR = 3.53, 95% CI: 2.81-4.43) at diagnosis were positively associated with suicide risk. Suicide rates were highest within 3 months following diagnosis and remained elevated in the 3-6- and 6-12-month periods following diagnosis. CONCLUSION Among Veteran VHA users, suicide risk was elevated following new cancer diagnoses. Risk was particularly high in the first 3 months. Additional screening and suicide prevention efforts may be warranted for VHA Veterans newly diagnosed with cancer.
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Affiliation(s)
- Kallisse R. Dent
- Veterans Affairs (VA) Serious Mental Illness Treatment Resource and Evaluation CenterOffice of Mental Health and Suicide PreventionAnn ArborMichiganUSA
| | - Benjamin R. Szymanski
- Veterans Affairs (VA) Serious Mental Illness Treatment Resource and Evaluation CenterOffice of Mental Health and Suicide PreventionAnn ArborMichiganUSA
| | - Michael J. Kelley
- Veterans Affairs (VA) National Oncology ProgramSpecialty Care Services, VAWashingtonDistrict of ColumbiaUSA,Duke Cancer InstituteDurhamNorth CarolinaUSA,Hematology‐OncologyDurham VA Health Care SystemDurhamNorth CarolinaUSA
| | - Ira R. Katz
- VA Office of Mental Health and Suicide PreventionWashingtonDistrict of ColumbiaUSA
| | - John F. McCarthy
- Veterans Affairs (VA) Serious Mental Illness Treatment Resource and Evaluation CenterOffice of Mental Health and Suicide PreventionAnn ArborMichiganUSA
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Kutney-Lee A, Khazanov GK, Carpenter JG, Griffin H, Kinder D, Shreve ST, Smith D, Thorpe JM, Ersek M. Palliative Care and Documented Suicide: Association Among Veterans With High Mortality Risk. J Pain Symptom Manage 2022; 64:e63-e69. [PMID: 35489665 DOI: 10.1016/j.jpainsymman.2022.04.179] [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: 02/04/2022] [Revised: 04/11/2022] [Accepted: 04/17/2022] [Indexed: 11/17/2022]
Abstract
CONTEXT Palliative care consultations (PCCs) are associated with reduced physical and psychological symptoms that are related to suicide risk. Little is known, however, about the association between PCCs and death from suicide among patients at high risk of short-term mortality. OBJECTIVE To examine the association between the number of PCCs and documentation of suicide in a cohort of Veterans at high risk of short-term mortality, before and after accounting for Veterans' sociodemographic characteristics and clinical conditions. METHODS An observational cohort study was conducted using linked Veterans Affairs clinical and administrative databases for 580,620 decedents with high risk of one-year mortality. Logistic regression models were used to examine the association between number of PCCs and documentation of suicide. RESULTS Higher percentages of Veterans who died by suicide were diagnosed with chronic pulmonary disease as well as mental health/substance use conditions compared with Veterans who died from other causes. In adjusted models, one PCC in the 90 days prior to death was significantly associated with a 71% decrease in the odds of suicide (OR = 0.29, 95% CI = 0.23-0.37, P < 0.001) and two or more PCCs were associated with a 78% decrease (OR = 0.22, 95% CI = 0.15-0.33, P < 0.001). Associated "number needed to be exposed" estimates suggest that 421 Veterans in this population would need to receive at least one PCC to prevent one suicide. CONCLUSION While acknowledging the importance of specialized mental health care in reducing suicide among high-risk patients, interventions delivered in the context of PCCs may also play a role.
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Affiliation(s)
- Ann Kutney-Lee
- Veteran Experience Center (A.K.L., J.G.C., H.G., D.K., D.S., J.M.T.,), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA; Center for Health Equity Research and Promotion (A.K.L., M.E.), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA; University of Pennsylvania School of Nursing (A.K.L., M.E.), Philadelphia, Pennsylvania, USA.
| | - Gabriela K Khazanov
- Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4 (G.K.K.), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Joan G Carpenter
- Veteran Experience Center (A.K.L., J.G.C., H.G., D.K., D.S., J.M.T.,), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA; University of Maryland School of Nursing (J.G.C.), Baltimore, Maryland, USA
| | - Hilary Griffin
- Veteran Experience Center (A.K.L., J.G.C., H.G., D.K., D.S., J.M.T.,), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Daniel Kinder
- Veteran Experience Center (A.K.L., J.G.C., H.G., D.K., D.S., J.M.T.,), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Scott T Shreve
- Palliative and Hospice Care Program Office (S.T.S.), US Department of Veterans Affairs, Washington, District of Columbia, USA; Penn State College of Medicine (S.T.S.), Hershey, Pennsylvania, USA
| | - Dawn Smith
- Veteran Experience Center (A.K.L., J.G.C., H.G., D.K., D.S., J.M.T.,), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Joshua M Thorpe
- Veteran Experience Center (A.K.L., J.G.C., H.G., D.K., D.S., J.M.T.,), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA; Center for Health Equity Research and Promotion (J.M.T.), Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania, USA; University of North Carolina School of Pharmacy (J.M.T.), Chapel Hill, North Carolina, USA
| | - Mary Ersek
- Center for Health Equity Research and Promotion (A.K.L., M.E.), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA; University of Pennsylvania School of Nursing (A.K.L., M.E.), Philadelphia, Pennsylvania, USA
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Hoyt T, Holliday R, Simonetti JA, Monteith LL. Firearm Lethal Means Safety with Military Personnel and Veterans: Overcoming Barriers using a Collaborative Approach. ACTA ACUST UNITED AC 2021; 52:387-395. [PMID: 34421193 DOI: 10.1037/pro0000372] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Suicides by firearm have increased over the past decade among United States service members and veterans. As firearm access is a suicide risk factor, firearm-related lethal means safety is critical to suicide prevention. However, identity, occupational, and cultural barriers may deter efforts to promote lethal means safety with service members and veterans. The current manuscript describes a collaborative framework to guide mental health providers' in conducting firearm-related lethal means safety with service members and veterans, including within the context of Safety Planning. In approaching firearm lethal means safety conversations with patients, clinicians must work to overcome their own reticence, address patient concerns directly, and remain culturally sensitive to the values of the military and veteran communities. This approach is illustrated using case vignettes that encompass addressing firearm-related lethal means safety with service members and veterans.
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Affiliation(s)
- Tim Hoyt
- Psychological Health Center of Excellence, Defense Health Agency
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention.,Department of Psychiatry, University of Colorado Anschutz Medical Campus
| | - Joseph A Simonetti
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention.,Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration.,Hospital Medicine Group, Rocky Mountain Regional VA Medical Center
| | - Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention.,Department of Psychiatry, University of Colorado Anschutz Medical Campus
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