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Hein TC, Austin K, Grau PP, Keith JA, Claes NJ, Bowersox NW. Predictors of non-fatal suicide attempts among Veterans Health Administration (VHA) patients who experienced military sexual trauma. Suicide Life Threat Behav 2024; 54:263-274. [PMID: 38421037 DOI: 10.1111/sltb.13038] [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: 03/07/2023] [Revised: 11/10/2023] [Accepted: 12/22/2023] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Military sexual trauma (MST) has been identified as a risk factor for suicidal behavior. To inform suicide prevention efforts within the Veterans Health Administration (VHA), this study evaluates predictors of non-fatal suicide attempts (NFSAs) among VHA patients who experienced MST. METHODS For VHA patients in fiscal year (FY) 2019 who previously screened positive for a history of MST, documented NFSAs were assessed. Using multivariable logistic regression, demographic, clinical, and VHA care utilization predictors of NFSAs were assessed. RESULTS Of the 212,215 VHA patients who screened positive for MST prior to FY 2019 and for whom complete race, service connection, and rurality information was available, 1742 (0.8%) had a documented NFSA in FY 2019. In multivariable logistic regression analyses, total physical and mental health morbidities were not associated with NFSA risk. Predictors of a documented NFSA included specific mental health diagnoses [adjusted odds ratio (aOR) range: 1.28-1.94], receipt of psychotropic medication prescriptions (aOR range: 1.23-2.69) and having a prior year emergency department visit (aOR = 1.32) or inpatient psychiatric admission (aOR = 2.15). CONCLUSIONS Among VHA patients who experienced MST, specific mental health conditions may increase risk of NFSAs, even after adjustment for overall mental health morbidity. Additionally, indicators of severity of mental health difficulties such as receipt of psychotropic medication prescriptions and inpatient psychiatric admissions are also associated with increased risk above and beyond risk associated with diagnoses. Findings highlight targets for suicide prevention initiatives among this vulnerable group within VHA and may help identify patients who would benefit from additional support.
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Affiliation(s)
- Tyler C Hein
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Office of Mental Health and Suicide Prevention (11MHSP), Ann Arbor, Michigan, USA
- TRAILS, a Project of Tides Center, Ann Arbor, Michigan, USA
| | - Karen Austin
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Office of Mental Health and Suicide Prevention (11MHSP), Ann Arbor, Michigan, USA
| | - Peter P Grau
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Office of Mental Health and Suicide Prevention (11MHSP), Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research (CCMR), Ann Arbor, Michigan, USA
| | - Jessica A Keith
- Department of Veterans Affairs, Military Sexual Trauma Support Team, Office of Mental Health and Suicide Prevention (11MHSP), Washington, DC, USA
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Nathan J Claes
- Department of Veterans Affairs, Military Sexual Trauma Support Team, Office of Mental Health and Suicide Prevention (11MHSP), Washington, DC, USA
| | - Nicholas W Bowersox
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Office of Mental Health and Suicide Prevention (11MHSP), Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research (CCMR), Ann Arbor, Michigan, USA
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Schmutte T, Krishnamurti LS, Davidson L, Klee A, Bullock J, Panas RM, Pfeiffer PN, Chinman M. Implementing Peer Specialists in Suicide Prevention Efforts in the Veterans Health Administration. Psychiatr Q 2023; 94:311-319. [PMID: 37278930 PMCID: PMC10424796 DOI: 10.1007/s11126-023-10034-x] [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] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The Veterans Health Administration (VHA) recognizes peer support as an underused intervention in suicide prevention. PREVAIL is a peer-based suicide prevention intervention that was designed and piloted with non-veteran patients recently hospitalized for suicidal thoughts or behaviors. The purpose of this study was to elicit veteran and stakeholder feedback to inform the adaptation of PREVAIL for piloting with veterans flagged for high suicide risk. METHODS Semi-structured interviews were conducted with multiple stakeholders from a VHA medical center in the northeast. Interviews focused on the perceived benefits and concerns of peer specialists directly addressing suicide risk with veterans. Interviews were recorded, transcribed, and analyzed using rapid qualitative analysis. RESULTS Interviewees included clinical directors (n = 3), suicide prevention coordinators (n = 1), outpatient psychologists (n = 2), peer specialists (n = 1), and high-risk veterans (n = 2). Overall, peer specialists were viewed as possessing many distinct strengths in engaging and helping high-risk veterans as part of a team approach. Concerns included liability, adequate training, clinical supervision and support, and self-care for peer specialists. CONCLUSIONS Findings indicated support and confidence that peer support specialists would be a valuable addition and could help fill existing gap in VHA's suicide prevention efforts.
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Affiliation(s)
- Timothy Schmutte
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Lauren S Krishnamurti
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Larry Davidson
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Anne Klee
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Joshua Bullock
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Raymond M Panas
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Paul N Pfeiffer
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Matthew Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- RAND Corporation, Pittsburgh, PA, USA
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Katz IR, Szymanski BR, Marder SR, Shotwell A, Hein TC, McCarthy JF, Bowersox NW. Comparative risks of all-cause mortality for Veterans with schizophrenia with ongoing receipt of clozapine and other antipsychotic medications. Psychiatry Res 2022; 313:114590. [PMID: 35567853 DOI: 10.1016/j.psychres.2022.114590] [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: 11/22/2021] [Revised: 02/15/2022] [Accepted: 04/30/2022] [Indexed: 11/18/2022]
Abstract
To guide care for patients with schizophrenia, the Veterans Health Administration (VHA) evaluated the associations between current or recent use of clozapine and all-cause mortality and explored associations for other antipsychotic medications. Using a case-control design, patients with schizophrenia who died in fiscal years 2014-2018 were matched on age, sex, race, and VHA facility to up to 10 controls who were alive on the case's date of death (index date). Medication coverage during the 91 days before the index date was classified as none, partial (1-44 days), and consistent (45-91 days). Medication coverage patterns during the index period were compared to coverage patterns during the period of 92-182 days prior to index date with each medication coverage classified as no change, no coverage, increased, or decreased. Conditional logistic regression analyses controlling for patient characteristics identified no associations of consistent or increasing clozapine coverage with mortality; partial and decreasing coverage were associated with greater mortality and these effects did not differ from those of other the medications considered. Exploratory analyses considering non-clozapine antipsychotic agents suggest that consistent coverage by olanzapine may be associated with increased mortality, that mortality associated with olanzapine may be greater than aripiprazole, and that this effect can be attributed primarily to patients with diabetes. Further study of this topic is needed.
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Affiliation(s)
- Ira R Katz
- Department of Veterans Affairs, VA Office of Mental Health and Suicide Prevention, Washington, DC, USA
| | - Benjamin R Szymanski
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, North Campus Research Complex, 2800 Plymouth Rd, Building 16, Room 016-233W, Ann Arbor, MI 48109, USA
| | - Stephen R Marder
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA; Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA
| | - Abigail Shotwell
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, North Campus Research Complex, 2800 Plymouth Rd, Building 16, Room 016-233W, Ann Arbor, MI 48109, USA
| | - Tyler C Hein
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, North Campus Research Complex, 2800 Plymouth Rd, Building 16, Room 016-233W, Ann Arbor, MI 48109, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - John F McCarthy
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, North Campus Research Complex, 2800 Plymouth Rd, Building 16, Room 016-233W, Ann Arbor, MI 48109, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nicholas W Bowersox
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, North Campus Research Complex, 2800 Plymouth Rd, Building 16, Room 016-233W, Ann Arbor, MI 48109, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
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