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Landes SJ, Matarazzo BB, Pitcock JA, Drummond KL, Smith BN, Kirchner JE, Clark KA, Gerard GR, Jankovsky MC, Brenner LA, Reger MA, Eagan AE, Raciborski R, Painter J, Townsend JC, Jegley SM, Singh RS, Trafton JA, McCarthy JF, Katz IR. Impact of Implementation Facilitation on the REACH VET Clinical Program for Veterans at Risk for Suicide. Psychiatr Serv 2024:appips20230277. [PMID: 38444365 DOI: 10.1176/appi.ps.20230277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
OBJECTIVE In 2017, the Veterans Health Administration (VHA) implemented a national suicide prevention program, called Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (REACH VET), that uses a predictive algorithm to identify, attempt to reach, assess, and care for patients at the highest risk for suicide. The authors aimed to evaluate whether facilitation enhanced implementation of REACH VET at VHA facilities not meeting target completion rates. METHODS In this hybrid effectiveness-implementation type 2 program evaluation, a quasi-experimental pre-post design was used to assess changes in implementation outcome measures evaluated 6 months before and 6 months after onset of facilitation of REACH VET implementation at 23 VHA facilities. Measures included percentages of patients with documented coordinator and provider acknowledgment of receipt, care evaluation, and outreach attempt. Generalized estimating equations were used to compare differences in REACH VET outcome measures before and after facilitation. Qualitative interviews were conducted with personnel and were explored via template analysis. RESULTS Time had a significant effect in all outcomes models (p<0.001). An effect of facilitation was significant only for the outcome of attempted outreach. Patients identified by REACH VET had significantly higher odds of having a documented outreach attempt after facilitation of REACH VET implementation, compared with before facilitation. Site personnel felt supported and reported that the external facilitators were helpful and responsive. CONCLUSIONS Facilitation of REACH VET implementation was associated with an improvement in outreach attempts to veterans identified as being at increased risk for suicide. Outreach is critical for engaging veterans in care.
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Affiliation(s)
- Sara J Landes
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Bridget B Matarazzo
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Jeffery A Pitcock
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Karen L Drummond
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Brandy N Smith
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - JoAnn E Kirchner
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Kaily A Clark
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Georgia R Gerard
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Molly C Jankovsky
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Lisa A Brenner
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Mark A Reger
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Aaron E Eagan
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Rebecca Raciborski
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Jacob Painter
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - James C Townsend
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Susan M Jegley
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Rajinder Sonia Singh
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Jodie A Trafton
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - John F McCarthy
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Ira R Katz
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
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Fischer IC, Pietrzak RH, Maercker A, Shalev AY, Katz IR, Harpaz-Rotem I. Post-traumatic stress disorder: rethinking diagnosis. Lancet Psychiatry 2023; 10:741-742. [PMID: 37499676 DOI: 10.1016/s2215-0366(23)00227-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Ian C Fischer
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA
| | - Robert H Pietrzak
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Andreas Maercker
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | - Arieh Y Shalev
- Department of Psychiatry, New York University Grossman School of Medicine New York, NY, USA
| | - Ira R Katz
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; US Department of Veterans, Office of Mental Health and Suicide Prevention, VA Central Office, Washington DC, USA
| | - Ilan Harpaz-Rotem
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA; Department of Psychology and the Wu Tsai Institute, Yale University, New Haven, CT, USA.
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Katz IR, Resnick SG, Liebmann EP, Hoff RA. Additional comparisons between PHQ-9 responses from clinical and survey data. Psychiatry Res 2023; 326:115286. [PMID: 37302356 DOI: 10.1016/j.psychres.2023.115286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/03/2023] [Indexed: 06/13/2023]
Affiliation(s)
- Ira R Katz
- VA Office of Mental Health and Suicide Prevention, Philadelphia, PA 19104, USA.
| | - Sandra G Resnick
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Edward P Liebmann
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Rani A Hoff
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
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Szmulewicz A, Madenci A, Ferguson R, Liang MH, Lew R, Katz IR, Hernán MA. Estimating the per-protocol effect of lithium on suicidality in a randomized trial of individuals with depression or bipolar disorder. J Psychopharmacol 2023:2698811231166460. [PMID: 37039306 DOI: 10.1177/02698811231166460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND The CSP590 randomized trial was designed to estimate the effect of lithium on suicidality. After a third of the intended number of participants were enrolled, the hazard ratio of suicidality was 1.10 (95% CI: 0.77, 1.55). Based on this, the trial was stopped for futility. However, only 17% of patients adhered to the specified protocol. AIMS The objective was to estimate the per-protocol effect of lithium on suicidality, that is, the effect of adhering to the treatment strategies as specified in the protocol. METHODS We stopped individuals' follow-up if/when they showed evidence of nonadherence. We then conducted the analysis in the restricted sample, adjusting for prognostic factors that predict adherence via inverse probability weighting. The primary outcome was the 12-month risk of suicidality (including death from suicide, suicide attempt, interrupted attempt, hospitalization specifically to prevent suicide). RESULTS The estimated 12-month risk of suicidality was 18.8% for lithium, and 24.3% for placebo. The risk ratio was 0.78 (95% CI: 0.43, 1.37) and the risk difference -5.5 percentage points (95% CI: -17.5, 5.5). Results were consistent across sensitivity analyses. CONCLUSIONS With one-third of the targeted sample size, lithium effects (compared with placebo) ranging between a 17.5% reduction and a 5.5% increase in the risk of suicidality were highly compatible with the data. Thus, a protective effect of lithium on suicidality among patients with bipolar disorder or major depressive disorder cannot be ruled out. Trials should incorporate adequate per-protocol analyses into the decision-making processes for stopping trials for futility.
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Affiliation(s)
- Alejandro Szmulewicz
- CAUSALab, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Arin Madenci
- CAUSALab, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ryan Ferguson
- Boston Cooperative Studies Coordinating Center, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Matthew H Liang
- Boston Cooperative Studies Coordinating Center, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Section of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Section of Rheumatology, VA Boston Healthcare System, Boston, MA, USA
| | - Robert Lew
- Boston Cooperative Studies Coordinating Center, VA Boston Healthcare System, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Ira R Katz
- Department of Psychiatry, Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Miguel A Hernán
- CAUSALab, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Liebmann EP, Resnick SG, Hoff RA, Katz IR. Outcomes for treatment of depression in the Veterans Health Administration: Rates of response and remission calculated from clinical and survey data. Psychiatry Res 2023; 324:115196. [PMID: 37058792 DOI: 10.1016/j.psychres.2023.115196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/05/2023] [Accepted: 04/09/2023] [Indexed: 04/16/2023]
Abstract
Healthcare Effectiveness Data and Information Set (HEDIS) quality measures for depression treatment aggregate Patient Health Questionnaire (PHQ)-9 data from routine clinical assessments recorded in electronic health records (EHR). To determine whether aggregated PHQ-9 data in US Veterans Health Administration (VHA) EHRs should be used to characterize the organization's performance, we compared rates for depression response and remission calculated from EHRs with rates calculated with data representing the underlying Veteran patient population estimated using Veterans Outcome Assessment (VOA) survey data. We analyzed data from initial assessments and 3-month follow-up for Veterans beginning treatment for depression. EHR data were available for only a minority of Veteran patients, and the group of Veterans with EHR data differed from the underlying Veteran patient population with respect to demographic and clinical characteristics. Aggregated rates of response and remission from EHR data were significantly different from estimates based on representative VOA data. The findings suggest that until patient-reported outcome from EHRs are available for a substantial majority of patients receiving care, aggregated measures of patient outcomes derived from these data cannot be assumed to be representative of the outcomes for the overall population, and they should not be used as outcome-based measures of quality or performance.
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Affiliation(s)
- Edward P Liebmann
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Sandra G Resnick
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Rani A Hoff
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Ira R Katz
- VA Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC 20420, United States.
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Matarazzo BB, Eagan A, Landes SJ, Mina LK, Clark K, Gerard GR, McCarthy JF, Trafton J, Bahraini NH, Brenner LA, Keen A, Gamble SA, Lawson WC, Katz IR, Reger MA. The Veterans Health Administration REACH VET Program: Suicide Predictive Modeling in Practice. Psychiatr Serv 2023; 74:206-209. [PMID: 36039552 DOI: 10.1176/appi.ps.202100629] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The U.S. Veterans Health Administration developed a suicide prediction statistical model and implemented a novel clinical program, Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (REACH VET). This high-value suicide prevention program aims to efficiently identify patients at risk and connect them with care. Starting in April 2017, national REACH VET metric data were collected from electronic health records to evaluate required task completion. By October 2020, 98% of veterans identified (N=6,579) were contacted by providers and had their care evaluated. In the nation's largest health care system, it was feasible to implement a clinical program based on a suicide prediction model.
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Affiliation(s)
- Bridget B Matarazzo
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Aaron Eagan
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Sara J Landes
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Liam K Mina
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Kaily Clark
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Georgia R Gerard
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - John F McCarthy
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Jodie Trafton
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Nazanin H Bahraini
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Angela Keen
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Stephanie A Gamble
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - W Cole Lawson
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Ira R Katz
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
| | - Mark A Reger
- Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs (VA) (Matarazzo, Clark, Gerard, Bahraini, Brenner, Lawson), and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado Anschutz Medical Campus (Matarazzo, Bahraini, Brenner), Aurora; Office of Mental Health and Suicide Prevention (OMHSP), VA, Washington, D.C. (Eagan, McCarthy, Katz); Quality Enhancement Research Initiative for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes); Program Evaluation and Resource Center, OMHSP, VA, Menlo Park, California (Mina, Trafton); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Veterans Integrated Service Network 4, VA, Pittsburgh (Keen); Center of Excellence for Suicide Prevention, Veterans Integrated Service Network 2, Canandaigua, New York, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Gamble); Puget Sound Health Care System, VA, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Reger)
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Kimbrel NA, Ashley-Koch AE, Qin XJ, Lindquist JH, Garrett ME, Dennis MF, Hair LP, Huffman JE, Jacobson DA, Madduri RK, Trafton JA, Coon H, Docherty AR, Mullins N, Ruderfer DM, Harvey PD, McMahon BH, Oslin DW, Beckham JC, Hauser ER, Hauser MA, Ashley-Koch AE, Aslan M, Beckham JC, Begoli E, Bhattacharya T, Brown B, Calhoun PS, Cheung KH, Choudhury S, Cliff AM, Cohn JD, Crivelli S, Cuellar-Hengartner L, Deangelis HE, Dennis MF, Dhaubhadel S, Finley PD, Ganguly K, Garvin MR, Gelernter JE, Hair LP, Harvey PD, Hauser ER, Hauser MA, Hengartner NW, Jacobson DA, Jones PC, Kainer D, Kaplan AD, Katz IR, Kember RL, Kimbrel NA, Kirby AC, Ko JC, Kolade B, Lagergren JH, Lane MJ, Levey DF, Levin D, Lindquist JH, Liu X, Madduri RK, Manore C, Martins SB, McCarthy JF, McDevitt-Cashman M, McMahon BH, Miller I, Morrow D, Oslin DW, Pavicic-Venegas M, Pestian J, Pyarajan S, Qin XJ, Rajeevan N, Ramsey CM, Ribeiro R, Rodriguez A, Romero J, Santel D, Schaefferkoetter N, Shi Y, Stein MB, Sullivan K, Sun N, Tamang SR, Townsend A, Trafton JA, Walker A, Wang X, Wangia-Anderson V, Yang R, Yoon HJ, Yoo S, Zamora-Resendiz R, Zhao H, Docherty AR, Mullins N, Coleman JRI, Shabalin A, Kang J, Murnyak B, Wendt F, Adams M, Campos AI, DiBlasi E, Fullerton JM, Kranzler HR, Bakian A, Monson ET, Rentería ME, Andreassen OA, Bulik CM, Edenberg HJ, Kessler RC, Mann JJ, Nurnberger JI, Pistis G, Streit F, Ursano RJ, Awasthi S, Bergen AW, Berrettini WH, Bohus M, Brandt H, Chang X, Chen HC, Chen WJ, Christensen ED, Crawford S, Crow S, Duriez P, Edwards AC, Fernández-Aranda F, Fichter MM, Galfalvy H, Gallinger S, Gandal M, Gorwood P, Guo Y, Hafferty JD, Hakonarson H, Halmi KA, Hishimoto A, Jain S, Jamain S, Jiménez-Murcia S, Johnson C, Kaplan AS, Kaye WH, Keel PK, Kennedy JL, Kim M, Klump KL, Levey DF, Li D, Liao SC, Lieb K, Lilenfeld L, Lori A, Magistretti PJ, Marshall CR, Mitchell JE, Myers RM, Okazaki S, Otsuka I, Pinto D, Powers A, Ramoz N, Ripke S, Roepke S, Rozanov V, Scherer SW, Schmahl C, Sokolowski M, Starnawska A, Strober M, Su MH, Thornton LM, Treasure J, Ware EB, Watson HJ, Witt SH, Woodside DB, Yilmaz Z, Zillich L, Agerbo E, Børglum AD, Breen G, Demontis D, Erlangsen A, Esko T, Gelernter J, Glatt SJ, Hougaard DM, Hwu HG, Kuo PH, Lewis CM, Li QS, Liu CM, Martin NG, McIntosh AM, Medland SE, Mors O, Nordentoft M, Nurnberger JI, Olsen C, Porteous D, Smith DJ, Stahl EA, Stein MB, Wasserman D, Werge T, Whiteman DC, Willour V, Coon H, Ruderfer DM, Dedert E, Elbogen EB, Fairbank JA, Hurley RA, Kilts JD, Martindale SL, Marx CE, McDonald SD, Moore SD, Morey RA, Naylor JC, Rowland J, Shura RD, Swinkels C, Tupler LA, Van Voorhees EE, Yoash-Gantz R, Gaziano JM, Muralidhar S, Ramoni R, Chang KM, O’Donnell CJ, Tsao PS, Breeling J, Hauser E, Sun Y, Huang G, Casas JP, Moser J, Whitbourne SB, Brewer JV, Conner T, Argyres DP, Stephens B, Brophy MT, Humphries DE, Selva LE, Do N, Shayan S(A, Cho K, Churby L, Wilson P, McArdle R, Dellitalia L, Mattocks K, Harley J, Whittle J, Jacono F, Wells J, Gutierrez S, Gibson G, Hammer K, Kaminsky L, Villareal G, Kinlay S, Xu J, Hamner M, Mathew R, Bhushan S, Iruvanti P, Godschalk M, Ballas Z, Ivins D, Mastorides S, Moorman J, Gappy S, Klein J, Ratcliffe N, Florez H, Okusaga O, Murdoch M, Sriram P, Yeh SS, Tandon N, Jhala D, Liangpunsakul S, Oursler KA, Whooley M, Ahuja S, Constans J, Meyer P, Greco J, Rauchman M, Servatius R, Gaddy M, Wallbom A, Morgan T, Stapley T, Sherman S, Ross G, Strollo P, Boyko E, Meyer L, Gupta S, Huq M, Fayad J, Hung A, Lichy J, Hurley R, Robey B, Striker R. Identification of Novel, Replicable Genetic Risk Loci for Suicidal Thoughts and Behaviors Among US Military Veterans. JAMA Psychiatry 2023; 80:135-145. [PMID: 36515925 PMCID: PMC9857322 DOI: 10.1001/jamapsychiatry.2022.3896] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Suicide is a leading cause of death; however, the molecular genetic basis of suicidal thoughts and behaviors (SITB) remains unknown. Objective To identify novel, replicable genomic risk loci for SITB. Design, Setting, and Participants This genome-wide association study included 633 778 US military veterans with and without SITB, as identified through electronic health records. GWAS was performed separately by ancestry, controlling for sex, age, and genetic substructure. Cross-ancestry risk loci were identified through meta-analysis. Study enrollment began in 2011 and is ongoing. Data were analyzed from November 2021 to August 2022. Main Outcome and Measures SITB. Results A total of 633 778 US military veterans were included in the analysis (57 152 [9%] female; 121 118 [19.1%] African ancestry, 8285 [1.3%] Asian ancestry, 452 767 [71.4%] European ancestry, and 51 608 [8.1%] Hispanic ancestry), including 121 211 individuals with SITB (19.1%). Meta-analysis identified more than 200 GWS (P < 5 × 10-8) cross-ancestry risk single-nucleotide variants for SITB concentrated in 7 regions on chromosomes 2, 6, 9, 11, 14, 16, and 18. Top single-nucleotide variants were largely intronic in nature; 5 were independently replicated in ISGC, including rs6557168 in ESR1, rs12808482 in DRD2, rs77641763 in EXD3, rs10671545 in DCC, and rs36006172 in TRAF3. Associations for FBXL19 and AC018880.2 were not replicated. Gene-based analyses implicated 24 additional GWS cross-ancestry risk genes, including FURIN, TSNARE1, and the NCAM1-TTC12-ANKK1-DRD2 gene cluster. Cross-ancestry enrichment analyses revealed significant enrichment for expression in brain and pituitary tissue, synapse and ubiquitination processes, amphetamine addiction, parathyroid hormone synthesis, axon guidance, and dopaminergic pathways. Seven other unique European ancestry-specific GWS loci were identified, 2 of which (POM121L2 and METTL15/LINC02758) were replicated. Two additional GWS ancestry-specific loci were identified within the African ancestry (PET112/GATB) and Hispanic ancestry (intergenic locus on chromosome 4) subsets, both of which were replicated. No GWS loci were identified within the Asian ancestry subset; however, significant enrichment was observed for axon guidance, cyclic adenosine monophosphate signaling, focal adhesion, glutamatergic synapse, and oxytocin signaling pathways across all ancestries. Within the European ancestry subset, genetic correlations (r > 0.75) were observed between the SITB phenotype and a suicide attempt-only phenotype, depression, and posttraumatic stress disorder. Additionally, polygenic risk score analyses revealed that the Million Veteran Program polygenic risk score had nominally significant main effects in 2 independent samples of veterans of European and African ancestry. Conclusions and Relevance The findings of this analysis may advance understanding of the molecular genetic basis of SITB and provide evidence for ESR1, DRD2, TRAF3, and DCC as cross-ancestry candidate risk genes. More work is needed to replicate these findings and to determine if and how these genes might impact clinical care.
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Affiliation(s)
- Nathan A. Kimbrel
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina,Veterans Affairs Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Allison E. Ashley-Koch
- Duke Molecular Physiology Institute, Durham, North Carolina,Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Xue J. Qin
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Duke Molecular Physiology Institute, Durham, North Carolina
| | - Jennifer H. Lindquist
- Veterans Affairs Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina
| | | | - Michelle F. Dennis
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Lauren P. Hair
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Jennifer E. Huffman
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Daniel A. Jacobson
- Biosciences, Oak Ridge National Laboratory, Oak Ridge, Tennessee,Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville,Department of Psychology, NeuroNet Research Center, University of Tennessee Knoxville
| | - Ravi K. Madduri
- Consortium for Advanced Science and Engineering, The University of Chicago, Chicago, Illinois,Data Science and Learning Division, Argonne National Laboratory, Lemont, Illinois
| | - Jodie A. Trafton
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - Hilary Coon
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City,Biomedical Informatics, University of Utah School of Medicine, Salt Lake City
| | - Anna R. Docherty
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City,Department of Psychiatry, Virginia Commonwealth University, Richmond
| | - Niamh Mullins
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Douglas M. Ruderfer
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida,Research Service, Bruce W. Carter VA Medical Center, Miami, Florida
| | - Benjamin H. McMahon
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, New Mexico
| | - David W. Oslin
- Veterans Integrated Service Networks 4 Mental Illness Research, Education, and Clinical Center, Center of Excellence, Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jean C. Beckham
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Elizabeth R. Hauser
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Duke Molecular Physiology Institute, Durham, North Carolina,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Michael A. Hauser
- Duke Molecular Physiology Institute, Durham, North Carolina,Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Allison E. Ashley-Koch
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mihaela Aslan
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jean C. Beckham
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Edmond Begoli
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Tanmoy Bhattacharya
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ben Brown
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Patrick S. Calhoun
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kei-Hoi Cheung
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sutanay Choudhury
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ashley M. Cliff
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| | - Judith D. Cohn
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| | - Silvia Crivelli
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| | - Leticia Cuellar-Hengartner
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| | - Haedi E. Deangelis
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| | - Michelle F. Dennis
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| | - Sayera Dhaubhadel
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| | - Patrick D. Finley
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| | - Kumkum Ganguly
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| | - Michael R. Garvin
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| | - Joel E. Gelernter
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| | - Lauren P. Hair
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| | - Phillip D. Harvey
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| | - Elizabeth R. Hauser
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| | - Michael A. Hauser
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| | - Nick W. Hengartner
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| | - Daniel A. Jacobson
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| | - Piet C. Jones
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| | - David Kainer
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| | - Alan D. Kaplan
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| | - Ira R. Katz
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| | - Rachel L. Kember
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| | - Nathan A. Kimbrel
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| | - Angela C. Kirby
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| | - John C. Ko
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| | - Beauty Kolade
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| | - John H. Lagergren
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| | - Matthew J. Lane
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| | - Daniel F. Levey
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| | - Drew Levin
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| | - Jennifer H. Lindquist
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| | - Xianlian Liu
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| | - Ravi K. Madduri
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| | - Carrie Manore
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| | - Susana B. Martins
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| | - John F. McCarthy
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| | - Mikaela McDevitt-Cashman
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| | - Benjamin H. McMahon
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| | - Izaak Miller
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| | - Destinee Morrow
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| | - David W. Oslin
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| | - Mirko Pavicic-Venegas
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| | - John Pestian
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| | - Saiju Pyarajan
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| | - Xue J. Qin
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| | - Nallakkandi Rajeevan
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| | - Christine M. Ramsey
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| | - Ruy Ribeiro
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| | - Alex Rodriguez
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| | - Jonathan Romero
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| | - Daniel Santel
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| | - Noah Schaefferkoetter
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| | - Yunling Shi
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| | - Murray B. Stein
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| | - Kyle Sullivan
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| | - Ning Sun
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| | - Suzanne R. Tamang
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| | - Alice Townsend
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| | - Jodie A. Trafton
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| | - Angelica Walker
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| | - Xiange Wang
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| | - Victoria Wangia-Anderson
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| | - Renji Yang
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| | - Hong-Jun Yoon
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| | - Shinjae Yoo
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| | - Rafael Zamora-Resendiz
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| | - Hongyu Zhao
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| | - Anna R Docherty
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| | - Niamh Mullins
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| | - Jonathan R I Coleman
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| | - Andrey Shabalin
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| | - JooEun Kang
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| | - Balasz Murnyak
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| | - Frank Wendt
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| | - Mark Adams
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| | - Adrian I Campos
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| | - Emily DiBlasi
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| | - Janice M Fullerton
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| | - Henry R Kranzler
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| | - Amanda Bakian
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| | - Eric T Monson
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| | - Miguel E Rentería
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| | - Ole A Andreassen
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| | - Cynthia M Bulik
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| | - Howard J Edenberg
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| | - Ronald C Kessler
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| | - J John Mann
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| | - John I. Nurnberger
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| | - Giorgio Pistis
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| | - Fabian Streit
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| | - Robert J Ursano
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| | - Swapnil Awasthi
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| | - Andrew W Bergen
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| | - Wade H Berrettini
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| | - Martin Bohus
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| | - Harry Brandt
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| | - Xiao Chang
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| | - Hsi-Chung Chen
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| | - Wei J Chen
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| | - Erik D Christensen
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| | - Steven Crawford
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| | - Scott Crow
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| | - Philibert Duriez
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| | - Alexis C Edwards
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| | - Fernando Fernández-Aranda
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| | - Manfred M Fichter
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| | - Hanga Galfalvy
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| | - Steven Gallinger
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| | - Michael Gandal
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| | - Philip Gorwood
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| | - Yiran Guo
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| | - Jonathan D Hafferty
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| | - Hakon Hakonarson
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| | - Katherine A Halmi
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| | - Akitoyo Hishimoto
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| | - Sonia Jain
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| | - Stéphane Jamain
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| | - Susana Jiménez-Murcia
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| | - Craig Johnson
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| | - Allan S Kaplan
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| | - Walter H Kaye
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| | - Pamela K Keel
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| | - James L Kennedy
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| | - Minsoo Kim
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| | - Kelly L Klump
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| | - Daniel F Levey
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| | - Dong Li
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| | - Shih-Cheng Liao
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| | - Klaus Lieb
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| | - Lisa Lilenfeld
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| | - Adriana Lori
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| | - Pierre J Magistretti
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Christian R Marshall
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - James E Mitchell
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Richard M Myers
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Satoshi Okazaki
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ikuo Otsuka
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Dalila Pinto
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Abigail Powers
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Nicolas Ramoz
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stephan Ripke
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stefan Roepke
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Vsevolod Rozanov
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stephen W Scherer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Christian Schmahl
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Marcus Sokolowski
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Anna Starnawska
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Michael Strober
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mei-Hsin Su
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Laura M Thornton
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Janet Treasure
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Erin B Ware
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Hunna J Watson
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stephanie H Witt
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - D Blake Woodside
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Zeynep Yilmaz
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Lea Zillich
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Esben Agerbo
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Anders D Børglum
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Gerome Breen
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ditte Demontis
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Annette Erlangsen
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Tõnu Esko
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Joel Gelernter
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stephen J Glatt
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - David M Hougaard
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Hai-Gwo Hwu
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Po-Hsiu Kuo
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Cathryn M Lewis
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Qingqin S Li
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Chih-Min Liu
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Nicholas G Martin
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Andrew M McIntosh
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sarah E Medland
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ole Mors
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Merete Nordentoft
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - John I Nurnberger
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Catherine Olsen
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - David Porteous
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Daniel J Smith
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Eli A Stahl
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Murray B Stein
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Danuta Wasserman
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Thomas Werge
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - David C Whiteman
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Virginia Willour
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Hilary Coon
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Douglas M Ruderfer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Eric Dedert
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Eric B. Elbogen
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - John A. Fairbank
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Robin A. Hurley
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jason D. Kilts
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sarah L. Martindale
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Christine E. Marx
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Scott D. McDonald
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Scott D. Moore
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Rajendra A. Morey
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jennifer C. Naylor
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jared Rowland
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Robert D. Shura
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Cindy Swinkels
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Larry A. Tupler
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Elizabeth E. Van Voorhees
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ruth Yoash-Gantz
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - J. Michael Gaziano
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sumitra Muralidhar
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Rachel Ramoni
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kyong-Mi Chang
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Christopher J. O’Donnell
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Philip S. Tsao
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - James Breeling
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Elizabeth Hauser
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Yan Sun
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Grant Huang
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Juan P. Casas
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jennifer Moser
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stacey B. Whitbourne
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jessica V. Brewer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Todd Conner
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Dean P. Argyres
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Brady Stephens
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mary T. Brophy
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Donald E. Humphries
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Luis E. Selva
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Nhan Do
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Shahpoor (Alex) Shayan
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kelly Cho
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Lori Churby
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Peter Wilson
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Rachel McArdle
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Louis Dellitalia
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kristin Mattocks
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - John Harley
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jeffrey Whittle
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Frank Jacono
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - John Wells
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Salvador Gutierrez
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Gretchen Gibson
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kimberly Hammer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Laurence Kaminsky
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Gerardo Villareal
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Scott Kinlay
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Junzhe Xu
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mark Hamner
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Roy Mathew
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sujata Bhushan
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Pran Iruvanti
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Michael Godschalk
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Zuhair Ballas
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Douglas Ivins
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stephen Mastorides
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jonathan Moorman
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Saib Gappy
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jon Klein
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Nora Ratcliffe
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Hermes Florez
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Olaoluwa Okusaga
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Maureen Murdoch
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Peruvemba Sriram
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Shing Shing Yeh
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Neeraj Tandon
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Darshana Jhala
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Suthat Liangpunsakul
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kris Ann Oursler
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mary Whooley
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sunil Ahuja
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Joseph Constans
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Paul Meyer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jennifer Greco
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Michael Rauchman
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Richard Servatius
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Melinda Gaddy
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Agnes Wallbom
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Timothy Morgan
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Todd Stapley
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Scott Sherman
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - George Ross
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Patrick Strollo
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Edward Boyko
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Laurence Meyer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Samir Gupta
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mostaqul Huq
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Joseph Fayad
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Adriana Hung
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jack Lichy
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Robin Hurley
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Brooks Robey
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Robert Striker
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
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8
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Katz IR, Liebmann EP, Resnick SG, Hoff RA, Schmidt EM. Progress toward a performance measure for mental health based on a generic patient- reported outcome measure: Findings from the Veterans Outcome Assessment survey. Psychiatry Res 2022; 317:114797. [PMID: 36030700 DOI: 10.1016/j.psychres.2022.114797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/29/2022]
Abstract
We report on studies conducted to develop outcome-based performance measures (PROM-PMs) based on generic patient-reported outcome measures (PROMs) that could support strategies for quality improvement applicable to all patients in a mental health system. Data were from the Veterans Outcome Assessment Survey at baseline and three months for the Mental Component Score (MCS-12), a widely used measure of mental health-related quality of life, for 15,540 outpatients beginning treatment in General Mental Health clinics in 140 Veterans Affairs (VA) facilities. Mental health diagnoses from medical records were coded using hierarchical categories. Mental health staffing levels and quality measures were from administrative data. Changes in MCS-12 scores were associated with demographics, baseline scores, and diagnostic categories; in fully adjusted models, differences between facilities accounted for only 0.5% of the total variance between patients. There were small but significant associations of both baseline and changes in MCS-12 scores with staffing levels and administrative measures of the quality of care that support the potential value of adjusted measures of changes in MCS-12 as a PROM-PM. Remaining issues include the low proportion of variability that can be attributed to differences between facilities and the associations of staffing and quality with possible case-mix adjustment variables.
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Affiliation(s)
- Ira R Katz
- VA Office of Mental Health and Suicide Prevention, Philadelphia, PA 19104, United States.
| | - Edward P Liebmann
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Sandra G Resnick
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Rani A Hoff
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Eric M Schmidt
- VA Office of Performance Measurement, Analytics and Performance Integration, Quality and Patient Safety, Veterans Health Administration, Menlo Park, CA 94025, United States; Center for Innovation to Implementation (Ci2i), VA Medical Center, Menlo Park, CA 94025, United States
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Gross GM, Pietrzak RH, Hoff RA, Katz IR, Harpaz-Rotem I. Risk for PTSD symptom worsening during new PTSD treatment episode in a nationally representative sample of treatment-seeking U.S. veterans with subthreshold PTSD. J Psychiatr Res 2022; 151:304-310. [PMID: 35526446 DOI: 10.1016/j.jpsychires.2022.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/03/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
Previous research has examined risk factors associated with poorer treatment outcomes for military Veterans with PTSD. However, work has not examined risk for symptom worsening among Veterans with subthreshold PTSD. The aim of this study was to examine demographic, psychiatric, physical health, and pre-treatment PTSD symptom clusters associated with clinically significant worsening of PTSD among a nationally representative sample of United States (U.S.) Veterans with subthreshold PTSD. Participants were Veterans (weighted N = 3162; unweighted N = 236) with subthreshold PTSD entering a new episode of treatment at U.S. Veterans Affairs PTSD specialty clinics during fiscal years 2018 and 2019. Data was collected as part of the Veterans Outcome Assessment, a yearly baseline and 3-month follow-up telephone survey. Analyses used weighted calculations to support the use of VOA data to draw inferences about all eligible Veterans, and binary logistic regression was used to examine risk factors for symptom worsening. Over 1/3 (37.7%) of Veterans with subthreshold PTSD experienced clinically significant symptom worsening from baseline to follow-up. Adjusted analyses revealed several risk factors for symptom worsening, including demographic (e.g., male sex, White race), psychiatric (personality and anxiety disorders), health care utilization (e.g., more primary care encounters in the previous year), physical health disability, and specific baseline PTSD symptom clusters (negative affect and anxious arousal). Findings suggest that Veterans with subthreshold symptoms seeking treatment for PTSD are at risk for symptom worsening, and highlight the importance of assessment, prevention, and treatment in targeting veterans with PTSD symptoms below the diagnostic threshold.
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Affiliation(s)
- Georgina M Gross
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA; Northeast Program Evaluation Center, VA Office of Mental Health and Suicide Prevention, West Haven VA Medical Center, West Haven, CT, USA.
| | - Robert H Pietrzak
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for PTSD, West Haven, CT, USA
| | - Rani A Hoff
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA; Northeast Program Evaluation Center, VA Office of Mental Health and Suicide Prevention, West Haven VA Medical Center, West Haven, CT, USA
| | - Ira R Katz
- VA Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC, USA; Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Ilan Harpaz-Rotem
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for PTSD, West Haven, CT, USA; Northeast Program Evaluation Center, VA Office of Mental Health and Suicide Prevention, West Haven VA Medical Center, West Haven, CT, USA
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Katz IR, Ferguson RE, Liang MH. Suicide Risk and Lithium-Reply. JAMA Psychiatry 2022; 79:513-514. [PMID: 35262638 DOI: 10.1001/jamapsychiatry.2022.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ira R Katz
- Department of Psychiatry, Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ryan E Ferguson
- Boston Cooperative Studies Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts.,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Matthew H Liang
- Boston Cooperative Studies Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts.,Section of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Section of Rheumatology, Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts
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13
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Liebmann EP, Resnick SG, Hoff RA, Katz IR. Interpreting patient reports of perceived change during treatment for depression: Findings from the Veterans Outcome Assessment survey. Psychiatry Res 2022; 309:114402. [PMID: 35114571 DOI: 10.1016/j.psychres.2022.114402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/07/2022] [Accepted: 01/15/2022] [Indexed: 11/29/2022]
Abstract
This study addressed ongoing questions about the meaning of patients' perceptions of change during treatment. The study used data from the Veterans Outcome Assessment survey for patients with a depressive disorder, without mental health comorbidities, treated in Department of Veterans Affairs general mental health clinics (n = 694). Perceived changes in problems/symptoms, other domains, and the quality of communication with providers were evaluated with items from the Experience of Care & Health Outcomes (ECHO) survey. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9). Linear regression models evaluated associations of perceived change at 3-months post-baseline with observed change in PHQ-9 scores, scores on other patient-reported outcome measures (PROMs), and ratings of communication with providers. Patients' reports of their clinical condition at follow-up together with ratings of communication accounted for approximately one-third of the variance in patients' perceptions of change. Adding change-scores based on baseline and follow-up scores on the PHQ-9 and other PROMs did not improve model fit. The findings suggest that patient reports of perceived change during treatment reflect their current clinical state and their experience of care more closely than actual changes in the PHQ-9 or other PROMs.
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Affiliation(s)
- Edward P Liebmann
- VA Connecticut Healthcare System, West Haven, CT, United States; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Sandra G Resnick
- VA Office of Mental Health and Suicide Prevention, Northeast Program Evaluation Center, West Haven, CT, United States; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Rani A Hoff
- VA Office of Mental Health and Suicide Prevention, Northeast Program Evaluation Center, West Haven, CT, United States; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Ira R Katz
- Department of Veterans Affairs, VA Office of Mental Health and Suicide Prevention, Washington, DC, United States.
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14
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Katz IR, Rogers MP, Lew R, Thwin SS, Doros G, Ahearn E, Ostacher MJ, DeLisi LE, Smith EG, Ringer RJ, Ferguson R, Hoffman B, Kaufman JS, Paik JM, Conrad CH, Holmberg EF, Boney TY, Huang GD, Liang MH. Lithium Treatment in the Prevention of Repeat Suicide-Related Outcomes in Veterans With Major Depression or Bipolar Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:24-32. [PMID: 34787653 PMCID: PMC8600458 DOI: 10.1001/jamapsychiatry.2021.3170] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Suicide and suicide attempts are persistent and increasing public health problems. Observational studies and meta-analyses of randomized clinical trials have suggested that lithium may prevent suicide in patients with bipolar disorder or depression. OBJECTIVE To assess whether lithium augmentation of usual care reduces the rate of repeated episodes of suicide-related events (repeated suicide attempts, interrupted attempts, hospitalizations to prevent suicide, and deaths from suicide) in participants with bipolar disorder or depression who have survived a recent event. DESIGN, SETTING, AND PARTICIPANTS This double-blind, placebo-controlled randomized clinical trial assessed lithium vs placebo augmentation of usual care in veterans with bipolar disorder or depression who had survived a recent suicide-related event. Veterans at 29 VA medical centers who had an episode of suicidal behavior or an inpatient admission to prevent suicide within 6 months were screened between July 1, 2015, and March 31, 2019. INTERVENTIONS Participants were randomized to receive extended-release lithium carbonate beginning at 600 mg/d or placebo. MAIN OUTCOMES AND MEASURES Time to the first repeated suicide-related event, including suicide attempts, interrupted attempts, hospitalizations specifically to prevent suicide, and deaths from suicide. RESULTS The trial was stopped for futility after 519 veterans (mean [SD] age, 42.8 [12.4] years; 437 [84.2%] male) were randomized: 255 to lithium and 264 to placebo. Mean lithium concentrations at 3 months were 0.54 mEq/L for patients with bipolar disorder and 0.46 mEq/L for patients with major depressive disorder. No overall difference in repeated suicide-related events between treatments was found (hazard ratio, 1.10; 95% CI, 0.77-1.55). No unanticipated safety concerns were observed. A total of 127 participants (24.5%) had suicide-related outcomes: 65 in the lithium group and 62 in the placebo group. One death occurred in the lithium group and 3 in the placebo group. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, the addition of lithium to usual Veterans Affairs mental health care did not reduce the incidence of suicide-related events in veterans with major depression or bipolar disorders who experienced a recent suicide event. Therefore, simply adding lithium to existing medication regimens is unlikely to be effective for preventing a broad range of suicide-related events in patients who are actively being treated for mood disorders and substantial comorbidities. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01928446.
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Affiliation(s)
- Ira R. Katz
- Department of Psychiatry, Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, Pennsylvania,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Malcolm P. Rogers
- Department of Psychiatry, VA Maine Healthcare System, Togus,Department of Psychiatry, Tufts University School of Medicine, Boston, Massachusetts
| | - Robert Lew
- Boston Cooperative Studies Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Soe Soe Thwin
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts,Department of Sexual and Reproductive Health and Rights, World Health Organization, Geneva, Switzerland
| | - Gheorghe Doros
- Boston Cooperative Studies Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Eileen Ahearn
- Department of Psychiatry, William S. Middleton VA Medical Center, Madison, Wisconsin,Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Michael J. Ostacher
- Department of Psychiatry, VA Palo Alto Healthcare System, Palo Alto, California,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Lynn E. DeLisi
- Department of Psychiatry, Cambridge Health Alliance, Cambridge Hospital, Cambridge, Massachusetts
| | - Eric G. Smith
- Department of Psychiatry, VA Bedford Healthcare System, Bedford, Massachusetts,Department of Psychiatry, University of Massachusetts Medical School, Worcester
| | - Robert J. Ringer
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - Ryan Ferguson
- Boston Cooperative Studies Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | | | - James S. Kaufman
- Department of Nephrology, VA New York Harbor Healthcare System, New York,Renal Division, New York University School of Medicine, New York
| | - Julie M. Paik
- New England Geriatric Research Education and Clinical Center and Renal Section, VA Boston Healthcare System, Boston, Massachusetts
| | - Chester H. Conrad
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts,Department of Cardiology, VA Boston Healthcare System, Boston, Massachusetts
| | - Erika F. Holmberg
- Boston Cooperative Studies Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Tamara Y. Boney
- Department of Psychiatry, Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, Pennsylvania
| | - Grant D. Huang
- Cooperative Studies Program, Office of Research and Development Department of Veterans Affairs, Washington, DC
| | - Matthew H. Liang
- Boston Cooperative Studies Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts,Department of Medicine, Section of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts,Department of Medicine, Section of Rheumatology, VA Boston Healthcare System, Boston, Massachusetts
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15
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Cooper SA, Szymanski BR, Karel MJ, Katz IR, McCarthy JF. Suicide among Veterans receiving Veterans Health Administration Home Based Primary Care and following discharge from Community Living Centers. Suicide Life Threat Behav 2021; 51:1055-1066. [PMID: 34333781 DOI: 10.1111/sltb.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/16/2020] [Accepted: 04/14/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Veterans who receive Veterans Health Administration (VHA) Home Based Primary Care (HBPC) services and those discharged from VHA Community Living Centers (CLC) may be at increased risk of suicide. No studies to date have assessed suicide risks among HBPC patients. This study examined suicide risks among recipients of VHA HBPC services and following discharge from VHA CLCs, as compared to other Veteran VHA users. METHODS We identified three cohorts of 2013 Veteran VHA patients: 47,842 HBPC users, 17,725 with live discharges from CLCs, and 5,554,635 other VHA users. Using proportional hazards regression, we assessed risk of suicide through 2016. RESULTS Overall, HBPC recipients did not differ from the other cohorts in suicide risk. Although in unadjusted analyses CLC discharged patients had greater suicide risk than the general VHA patient cohort (hazard ratio (HR) = 1.73, 95% confidence interval = 1.25-2.41), this became nonsignificant when controlling for diagnoses. CONCLUSIONS Overall findings did not identify differential suicide risk among VHA HBPC recipients in 2013, when compared to other Veteran VHA patient cohorts. Veterans discharged from VHA CLCs have increased mental health morbidity, which was associated with increased suicide risk.
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Affiliation(s)
- Samantha A Cooper
- US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
| | - Benjamin R Szymanski
- US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
| | - Michele J Karel
- US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Washington, DC, USA
| | - Ira R Katz
- US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - John F McCarthy
- US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA
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McCarthy JF, Cooper SA, Dent KR, Eagan AE, Matarazzo BB, Hannemann CM, Reger MA, Landes SJ, Trafton JA, Schoenbaum M, Katz IR. Evaluation of the Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment Suicide Risk Modeling Clinical Program in the Veterans Health Administration. JAMA Netw Open 2021; 4:e2129900. [PMID: 34661661 PMCID: PMC8524305 DOI: 10.1001/jamanetworkopen.2021.29900] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE The Veterans Health Administration (VHA) implemented a national clinical program using a suicide risk prediction algorithm, Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (REACH VET), in which clinicians facilitate care enhancements for individuals identified in local top 0.1% suicide risk tiers. Evaluation studies are needed. OBJECTIVE To determine associations with treatment engagement, health care utilization, suicide attempts, safety plan documentation, and 6-month mortality. DESIGN, SETTING, AND PARTICIPANTS This cohort study used triple differences analyses comparing 6-month changes in outcomes after vs before program entry for individuals entering the REACH VET program (March 2017-December 2018) vs a similarly identified top 0.1% suicide risk tier cohort from prior to program initiation (March 2014-December 2015), adjusting for trends across subthreshold cohorts. Subcohort analyses (including individuals from March 2017-June 2018) evaluated difference-in-differences for cause-specific mortality using death certificate data. The subthreshold cohorts included individuals in the top 0.3% to 0.1% suicide risk tier, below the threshold for REACH VET eligibility, from the concurrent REACH VET period and from the pre-REACH VET period. Data were analyzed from December 2019 through September 2021. EXPOSURES REACH VET-designated clinicians treatment reevaluation and outreach for care enhancements, including safety planning, increased monitoring, and interventions to enhance coping. MAIN OUTCOMES AND MEASURES Process outcomes included VHA scheduled, completed, and missed appointments; mental health visits; and safety plan documentation and documentation within 6 months for individuals without plans within the prior 2 years. Clinical outcomes included mental health admissions, emergency department visits, nonfatal suicide attempts, and all-cause, suicide, and nonsuicide external-cause mortality. RESULTS A total of 173 313 individuals (mean [SD] age, 51.0 [14.7] years; 161 264 [93.1%] men and 12 049 [7.0%] women) were included in analyses, including 40 816 individuals eligible for REACH VET care and 36 604 individuals from the pre-REACH VET period in the top 0.1% of suicide risk. The REACH VET intervention was associated with significant increases in completed outpatient appointments (adjusted triple difference [ATD], 0.31; 95% CI, 0.06 to 0.55) and proportion of individuals with new safety plans (ATD, 0.08; 95% CI, 0.06 to 0.10) and reductions in mental health admissions (ATD, -0.08; 95% CI, -0.10 to -0.05), emergency department visits (ADT, -0.03; 95% CI, -0.06 to -0.01), and suicide attempts (ADT, -0.05; 95% CI, -0.06 to -0.03). Subcohort analyses did not identify differences in suicide or all-cause mortality (eg, age-and-sex-adjusted difference-in-difference for suicide mortality, 0.0007; 95% CI, -0.0006 to 0.0019). CONCLUSIONS AND RELEVANCE These findings suggest that REACH VET implementation was associated with greater treatment engagement and new safety plan documentation and fewer mental health admissions, emergency department visits, and suicide attempts. Clinical programs using risk modeling may be effective tools to support care enhancements and risk reduction.
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Affiliation(s)
- John F. McCarthy
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, District of Columbia
| | - Samantha A. Cooper
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, District of Columbia
| | - Kallisse R. Dent
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, District of Columbia
| | - Aaron E. Eagan
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, District of Columbia
| | - Bridget B. Matarazzo
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs, Aurora, Colorado
| | - Claire M. Hannemann
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, District of Columbia
| | - Mark A. Reger
- VA Puget Sound Healthcare System, Seattle, Washington
| | - Sara J. Landes
- South Central Mental Illness Research Education Clinical Center, Department of Veterans Affairs, Little Rock, Arkansas
| | - Jodie A. Trafton
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, District of Columbia
| | | | - Ira R. Katz
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, District of Columbia
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Hannemann CM, Katz IR, McCarthy ME, Hughes GJ, McKeon R, McCarthy JF. Suicide mortality and related behavior following calls to the Veterans Crisis Line by Veterans Health Administration patients. Suicide Life Threat Behav 2021; 51:596-605. [PMID: 33373061 DOI: 10.1111/sltb.12722] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/21/2020] [Accepted: 10/07/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess outcomes for Veterans Health Administration (VHA) patients following calls to the Veterans Crisis Line (VCL). METHODS 158,927 VHA patients had an initial VCL call in 2010-2015 with documented identifiers. Multivariable proportional hazards regressions assessed risks of suicide and suicide-related behavior through 12 months. Covariates included age, sex, region, mental health encounters in the prior year, time of day, weekday/weekend status, call outcome, and responder determination of caller risk. RESULTS Annualized suicide rates per 100,000 within 1, 3, 6, and 12 months were 797, 520, 387, and 298, respectively. Average age was 49.9 (SD = 15.2), 86.5% were male, 68.6% received mental health encounters in the prior year, and 5.9% had calls categorized as at high risk. Adjusting for covariates, suicide risk was greater among male callers and those with calls categorized as at high or moderate risk. CONCLUSIONS Veterans Crisis Line serves a high-risk population at a critical time. Rates were particularly high within one month and remained substantially elevated through 12 months. Findings have directly informed ongoing efforts to enhance coordination between VCL and VHA to support suicide prevention.
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Affiliation(s)
- Claire M Hannemann
- Office of Mental Health and Suicide Prevention (OMHSP), Department of Veterans Affairs, Washington, DC, USA
| | - Ira R Katz
- Office of Mental Health and Suicide Prevention (OMHSP), Department of Veterans Affairs, Washington, DC, USA
| | | | - Gregory J Hughes
- Office of Mental Health and Suicide Prevention (OMHSP), Department of Veterans Affairs, Washington, DC, USA
| | - Richard McKeon
- Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
| | - John F McCarthy
- Office of Mental Health and Suicide Prevention (OMHSP), Department of Veterans Affairs, Washington, DC, USA
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Liebmann EP, Resnick SG, Hoff RA, Katz IR. Associations between patient experience and clinical outcomes in substance use disorder clinics: Findings from the veterans outcomes assessment survey. J Subst Abuse Treat 2021; 133:108505. [PMID: 34148757 DOI: 10.1016/j.jsat.2021.108505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patient-centeredness is a cornerstone of substance use disorder (SUD) treatment. Patient-experience measures are potential tools for the routine assessment of patient-centered SUD care and may be valuable measures to inform quality monitoring improvement efforts. Little research exists on the predictive validity of patient-experience measures in SUD care. PURPOSE We report on findings from the Veterans Outcome Assessment (VOA) survey that provides information on Veterans Health Administration SUD specialty care at treatment initiation and approximately 3-months post-initiation. METHODS The VOA includes patient-reported outcomes across multiple domains, including the Brief Addiction Monitor (BAM-R), the Short-Form-12 (SF-12) and the Experience of Care and Health Outcome Survey (ECHO), and provides patient reports of the quality of provider communication and overall quality of SUD care. RESULTS Nearly 40% of veterans in SUD care gave the highest possible ratings for communication and quality at both baseline and follow-up. Ratings of communication at 3-months were associated with treatment discontinuation and both ratings of communication and quality at 3-months and were independently associated with SUD symptoms and with mental well-being at 3-months. CONCLUSIONS This study provides preliminary support for the inclusion of patient experience measures, particularly ratings of provider communication, as part of routine assessment in SUD care. However, further work on the validity of ratings of provider communication using additional methodologies is likely important before piloting the inclusion of such measures in routine assessment, such as in measurement base care.
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Affiliation(s)
- Edward P Liebmann
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, USA.
| | - Sandra G Resnick
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, USA; Northeast Program Evaluation Center, VA Office of Mental Health and Suicide Prevention, West Haven VA Medical Center, West Haven, CT, USA
| | - Rani A Hoff
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, USA; Northeast Program Evaluation Center, VA Office of Mental Health and Suicide Prevention, West Haven VA Medical Center, West Haven, CT, USA
| | - Ira R Katz
- VA Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC, USA; Philadelphia VA Medical Center, Philadelphia, PA, USA
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Szymanski BR, Hein TC, Schoenbaum M, McCarthy JF, Katz IR. Facility-Level Excess Mortality of VHA Patients With Mental Health or Substance Use Disorder Diagnoses. Psychiatr Serv 2021; 72:408-414. [PMID: 33502219 DOI: 10.1176/appi.ps.202000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Individuals with mental or substance use disorders have higher mortality rates than people in the general population. How excess mortality varies across health care facilities is unknown. The authors sought to investigate facility-level mortality rates among Veterans Health Administration (VHA) patients who had received diagnoses of mental or substance use disorders. METHODS An electronic medical records-based retrospective cohort study was conducted, encompassing 8,812,373 unique users of 139 VHA facilities from 2011 to 2016. Covariates included age, sex, and past-year diagnoses of serious mental illness, posttraumatic stress disorder, major depressive disorder, other mental health conditions, or substance use disorders. The outcome was all-cause mortality per comprehensive Veterans Affairs/Department of Defense searches of the National Death Index. Proportional hazards regression was used to calculate overall and facility-specific hazard ratios (HRs) for each diagnosis group, adjusted for age, sex, and comorbid medical conditions. RESULTS Overall, all-cause mortality was statistically significantly elevated among VHA users with mental health diagnoses (HR=1.21, 95% confidence interval=1.20-1.22). HRs varied across facilities consistently over time. At the VHA facility level, diagnostic groups were significantly correlated with the degree of excess mortality. Results were similar in sensitivity analyses that excluded deaths from suicide or drug or alcohol overdose. CONCLUSIONS VHA users with mental or substance use disorder diagnoses had elevated mortality rates. Correlation in excess mortality across two periods indicated that facility differences in excess mortality were persistent and therefore potentially associated with facility- and community-level factors, which may help inform quality improvement efforts to reduce mortality rates.
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Affiliation(s)
- Benjamin R Szymanski
- Serious Mental Illness Treatment Resource and Evaluation Center, U.S. Department of Veterans Affairs, Ann Arbor, Michigan (Szymanski, Hein, McCarthy); Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland (Schoenbaum); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs, Philadelphia (Katz)
| | - Tyler C Hein
- Serious Mental Illness Treatment Resource and Evaluation Center, U.S. Department of Veterans Affairs, Ann Arbor, Michigan (Szymanski, Hein, McCarthy); Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland (Schoenbaum); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs, Philadelphia (Katz)
| | - Michael Schoenbaum
- Serious Mental Illness Treatment Resource and Evaluation Center, U.S. Department of Veterans Affairs, Ann Arbor, Michigan (Szymanski, Hein, McCarthy); Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland (Schoenbaum); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs, Philadelphia (Katz)
| | - John F McCarthy
- Serious Mental Illness Treatment Resource and Evaluation Center, U.S. Department of Veterans Affairs, Ann Arbor, Michigan (Szymanski, Hein, McCarthy); Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland (Schoenbaum); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs, Philadelphia (Katz)
| | - Ira R Katz
- Serious Mental Illness Treatment Resource and Evaluation Center, U.S. Department of Veterans Affairs, Ann Arbor, Michigan (Szymanski, Hein, McCarthy); Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland (Schoenbaum); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs, Philadelphia (Katz)
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Affiliation(s)
- Benjamin R Szymanski
- Serious Mental Illness Treatment and Resource Evaluation Center, U.S. Department of Veterans Affairs (VA), Ann Arbor, Michigan (all authors); VA Office of Mental Health and Suicide Prevention, Washington, DC (Szymanski, Hein)
| | - Tyler C Hein
- Serious Mental Illness Treatment and Resource Evaluation Center, U.S. Department of Veterans Affairs (VA), Ann Arbor, Michigan (all authors); VA Office of Mental Health and Suicide Prevention, Washington, DC (Szymanski, Hein)
| | - Ira R Katz
- Serious Mental Illness Treatment and Resource Evaluation Center, U.S. Department of Veterans Affairs (VA), Ann Arbor, Michigan (all authors); VA Office of Mental Health and Suicide Prevention, Washington, DC (Szymanski, Hein)
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Katz IR, Resnick S, Hoff R. Associations between patient experience and clinical outcomes in general mental health clinics: Findings from the veterans outcomes assessment survey. Psychiatry Res 2021; 295:113554. [PMID: 33183768 DOI: 10.1016/j.psychres.2020.113554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/31/2020] [Indexed: 01/27/2023]
Abstract
For mental health, evidence linking the patients' experiences of care with treatment outcomes is limited. We report findings from the Veterans Outcome Assessment (VOA) survey of Veterans beginning treatment in Veterans Health Administration (VHA) mental health programs with follow-up after approximately 3 months. In addition to assessments of symptoms and functioning, it includes key components of the Experience of Care and Health Outcomes (ECHO) survey including patient reports of communication with clinicians and of the overall quality of mental health care. For Veterans treated in VHA general mental health clinics, significant associations between ratings of communication and quality at baseline, and both retention in treatment and patient-reported outcomes assessed at follow-up demonstrate that better patient experience predicts more favorable outcomes. Further research is necessary to determine whether including them in measurement-based care could improve outcomes by facilitating the early identification of problems in providing care.
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Affiliation(s)
- Ira R Katz
- VA Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC; Philadelphia VA Medical Center, Philadelphia, PA.
| | - Sandra Resnick
- Northeast Program Evaluation Center, VA Office of Mental Health and Suicide Prevention, West Haven VA Medical Center, West Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Rani Hoff
- Northeast Program Evaluation Center, VA Office of Mental Health and Suicide Prevention, West Haven VA Medical Center, West Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT
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Abstract
IMPORTANCE The Veterans Health Administration (VHA) serves a population of veterans with a high prevalence of comorbid health conditions and increased risk for suicide. OBJECTIVE To replicate the findings of a previous study and assess whether exposure to angiotensin receptor blockers (ARBs) is associated with differential suicide risk compared with angiotensin-converting enzyme inhibitors (ACEIs) among veterans receiving VHA care. DESIGN, SETTING, AND PARTICIPANTS This nested case-control design included all suicide decedents from 2015 to 2017 with a VHA inpatient or outpatient encounter in the prior year and with either an active ACEI or ARB prescription in the 100 days prior to death. Using a 4:1 ratio, controls were matched to cases by age, sex, and hypertension and diabetes diagnoses. Controls were alive at the time of the death of the matched case, had a VHA encounter within the previous year, and had either an active ACEI or ARB medication fill within 100 days before the death of the matched case. EXPOSURES An active ACEI or ARB prescription within 100 days before the death of the case. MAIN OUTCOMES AND MEASURES Cases were suicide decedents from 2015 to 2017 per National Death Index search results included in the Veteran Affairs/Department of Defense Mortality Data Repository. RESULTS Among 1309 cases, the median (interquartile range [IQR]) age was 68 (60-76) years and among 5217 controls, the median (IQR) age was 67 (60-76) years, and 1.9% of veterans in both groups were female. ARBs were received by 20.2% of controls and 19.6% of cases; ACEIs were received by 79.8% of controls and 80.4% of cases. The crude suicide odds ratio for ARBs vs ACEIs was 0.966 (95% CI, 0.828-1.127). Controlling for covariates, the adjusted odds ratio for ARBs was 0.985 (95% CI, 0.834-1.164). Sensitivity analyses using only those covariates that differed significantly between groups, restricting to veterans ages 65 and older, dropping matching criteria, and adjusting for the quantity and temporal proximity of ACEI and ARB exposure in the 100 days prior to the index date, had consistent findings. CONCLUSIONS AND RELEVANCE This case-control study did not identify differences in suicide risk by receipt of ARBs vs ACEIs in analyses specific to veterans receiving VHA care in contrast with findings from the referent study.
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Affiliation(s)
- Kallisse R. Dent
- Veterans Affairs (VA) Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Ann Arbor, Michigan
| | - Cameron A. Griffin
- Veterans Affairs (VA) Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Ann Arbor, Michigan
| | - John F. McCarthy
- Veterans Affairs (VA) Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Ann Arbor, Michigan
| | - Ira R. Katz
- VA Office of Mental Health and Suicide Prevention, Washington, DC
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Ahearn EP, Szymanski BR, Chen P, Sajatovic M, Katz IR, McCarthy JF. Increased Risk of Dementia Among Veterans With Bipolar Disorder or Schizophrenia Receiving Care in the VA Health System. Psychiatr Serv 2020; 71:998-1004. [PMID: 32517643 PMCID: PMC8011612 DOI: 10.1176/appi.ps.201900325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The Veterans Health Administration (VHA) provides a continuum of care over the life course. Among U.S. adults, bipolar disorder and schizophrenia are associated with increased risk of dementia. To inform service planning, this study assessed the incidence of dementia among veteran VHA patients with bipolar disorder or schizophrenia, with adjustment for comorbid medical conditions. METHODS Using data from the VHA Corporate Data Warehouse, the authors identified all veterans who received VHA care in 2004 and 2005 without a dementia diagnosis and who were alive and between ages 18 and 100 as of January 1, 2006. Individuals were categorized as having bipolar disorder, schizophrenia, or neither condition on the basis of diagnoses in 2004-2005. Among ongoing VHA users, incidence of dementia was assessed for up to 10 years (2006-2015). RESULTS The cohort included 3,648,852 individuals. After analyses controlled for baseline comorbid general medical conditions and substance use disorders, the incidence rate ratios (IRRs) for dementia were 2.92 for those with schizophrenia and 2.26 for those with bipolar disorder, compared with VHA patients with neither condition. CONCLUSIONS Among veterans receiving VHA care, diagnoses of bipolar disorder and schizophrenia were each associated with increased risk of receiving a new diagnosis of dementia, even when analyses controlled for baseline medical comorbidities. IRRs were elevated for patients with either condition, compared with those with neither condition, and highest for those with schizophrenia. VHA clinicians should evaluate patients for dementia when signs or symptoms of cognitive impairment are present.
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Affiliation(s)
- Eileen P Ahearn
- Department of Psychiatry, William S. Middleton Department of Veterans Affairs (VA) Hospital, Madison, Wisconsin, and Department of Psychiatry, University of Wisconsin-Madison, Madison (Ahearn); Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (Szymanski, Katz, McCarthy); Department of Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland (Chen); Department of Psychiatry, Case Western Reserve University, Cleveland (Chen, Sajatovic)
| | - Benjamin R Szymanski
- Department of Psychiatry, William S. Middleton Department of Veterans Affairs (VA) Hospital, Madison, Wisconsin, and Department of Psychiatry, University of Wisconsin-Madison, Madison (Ahearn); Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (Szymanski, Katz, McCarthy); Department of Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland (Chen); Department of Psychiatry, Case Western Reserve University, Cleveland (Chen, Sajatovic)
| | - Peijun Chen
- Department of Psychiatry, William S. Middleton Department of Veterans Affairs (VA) Hospital, Madison, Wisconsin, and Department of Psychiatry, University of Wisconsin-Madison, Madison (Ahearn); Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (Szymanski, Katz, McCarthy); Department of Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland (Chen); Department of Psychiatry, Case Western Reserve University, Cleveland (Chen, Sajatovic)
| | - Martha Sajatovic
- Department of Psychiatry, William S. Middleton Department of Veterans Affairs (VA) Hospital, Madison, Wisconsin, and Department of Psychiatry, University of Wisconsin-Madison, Madison (Ahearn); Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (Szymanski, Katz, McCarthy); Department of Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland (Chen); Department of Psychiatry, Case Western Reserve University, Cleveland (Chen, Sajatovic)
| | - Ira R Katz
- Department of Psychiatry, William S. Middleton Department of Veterans Affairs (VA) Hospital, Madison, Wisconsin, and Department of Psychiatry, University of Wisconsin-Madison, Madison (Ahearn); Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (Szymanski, Katz, McCarthy); Department of Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland (Chen); Department of Psychiatry, Case Western Reserve University, Cleveland (Chen, Sajatovic)
| | - John F McCarthy
- Department of Psychiatry, William S. Middleton Department of Veterans Affairs (VA) Hospital, Madison, Wisconsin, and Department of Psychiatry, University of Wisconsin-Madison, Madison (Ahearn); Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (Szymanski, Katz, McCarthy); Department of Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland (Chen); Department of Psychiatry, Case Western Reserve University, Cleveland (Chen, Sajatovic)
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Katz IR, Resnick SG, Kasprow WJ, Boden MT, Cherkasova E, Fielstein EM, Trafton JA, Hoff RA. Using patient-reported outcome measures for program evaluation: Design and findings on intention-to-treat outcomes from the Veterans Outcome Assessment survey. Psychiatry Res 2020; 291:113226. [PMID: 32590230 DOI: 10.1016/j.psychres.2020.113226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/15/2022]
Abstract
The Veterans Outcomes Assessment (VOA) program surveys Veteran Health Administration (VHA) patients when they begin mental health treatment and at follow-up at three months to obtain patient-reported outcomes measures (PROM). It complements VA's evolving program in measurement-based care by providing additional data that can be useful for program evaluation including assessments of patients who have not been seen for ongoing mental health care. In principle, it provides data on intention-to-treat outcomes for program evaluation to complement the outcomes for patients who are receiving ongoing treatment that can be derived from measurement-based care. VOA findings confirm differences in outcomes between patients who have continued to be seen for treatment and those who have not. Patients in general mental health clinics with no encounters between the baseline and follow-up assessments who reported discontinuing care because they did not want or need treatment improved more, and those who discontinued due to problems improved less than those who remained in treatment. Experience with VOA has identified a number of issues that must be addressed before it is possible to use intention-to-treat outcomes for program evaluation.
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Affiliation(s)
- Ira R Katz
- VA Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC, USA; Philadelphia VA Medical Center, 4100 Chester Ave, Philadelphia 19104 PA, Philadelphia, USA.
| | - Sandra G Resnick
- Northeast Program Evaluation Center, VA Office of Mental Health and Suicide Prevention, West Haven VA Medical Center, West Haven CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Wesley J Kasprow
- Northeast Program Evaluation Center, VA Office of Mental Health and Suicide Prevention, West Haven VA Medical Center, West Haven CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Matthew Tyler Boden
- Program Evaluation Resource Center, VA Office of Mental Health and Suicide Prevention, Palo Alto VA Healthcare System, Palo Alto, CA, USA; Center for Innovation to Implementation, Palo Alto VA Healthcare System, Palo Alto, CA, USA
| | - Elena Cherkasova
- Program Evaluation Resource Center, VA Office of Mental Health and Suicide Prevention, Palo Alto VA Healthcare System, Palo Alto, CA, USA
| | - Elliot M Fielstein
- Informatics Section, VA Office of Mental Health and Suicide Prevention, Washington, DC, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jodie A Trafton
- Program Evaluation Resource Center, VA Office of Mental Health and Suicide Prevention, Palo Alto VA Healthcare System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Rani A Hoff
- Northeast Program Evaluation Center, VA Office of Mental Health and Suicide Prevention, West Haven VA Medical Center, West Haven CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Peltzman T, Ravindran C, Schoen PM, Morley SW, Drexler K, Katz IR, McCarthy JF. Brief Report: Opioid-Involved Overdose Mortality in United States Veterans. Am J Addict 2020; 29:340-344. [PMID: 32223045 DOI: 10.1111/ajad.13027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/02/2020] [Accepted: 03/11/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study is to assess trends in opioid-involved overdose mortality among US Veterans. METHODS Age-adjusted drug overdose mortality rates, overall and by opioid subtype, were assessed from National Death Index data for US Veterans; statistical significance of trends was assessed for 2010 to 2015 and 2015 to 2016. RESULTS Veteran age-adjusted overdose mortality rates increased 23.7% from 2010 to 2015 (19.7-24.4 of 100 000) and a further 20.4% through 2016 (29.3 of 100 000). Opioid involvement increased from 51.3% in 2010 to 62.1% in 2016, as opioid overdose rates increased from 10.9 to 19.5 of 100 000. Overdose mortality varied substantially by opioid subtype and demographics. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE This report provides the first-ever description of trends and characteristics of overdose mortality and opioid-involved deaths among US Veterans of military service for the period 2010 to 2016. With the exception of female Veterans and Veterans in Western States, it has been found that trends in Veteran overdose mortality paralleled rising rates of drug overdose observed in the United States more broadly. Published 2020. This article is a U.S. Government work and is in the public domain in the USA. (Am J Addict 2020;00:00-00).
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Affiliation(s)
- Talya Peltzman
- Office of Mental Health and Suicide Prevention, Veterans Health Administration (VA), Washington, District of Columbia
| | - Chandru Ravindran
- Office of Mental Health and Suicide Prevention, Veterans Health Administration (VA), Washington, District of Columbia
| | - Patrick M Schoen
- Office of Mental Health and Suicide Prevention, Veterans Health Administration (VA), Washington, District of Columbia
| | - Sybil W Morley
- Office of Mental Health and Suicide Prevention, Veterans Health Administration (VA), Washington, District of Columbia
| | - Karen Drexler
- Office of Mental Health and Suicide Prevention, Veterans Health Administration (VA), Washington, District of Columbia
| | - Ira R Katz
- Office of Mental Health and Suicide Prevention, Veterans Health Administration (VA), Washington, District of Columbia
| | - John F McCarthy
- Office of Mental Health and Suicide Prevention, Veterans Health Administration (VA), Washington, District of Columbia
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Katz IR, Dent KR, Morley SW, Hein TC, Hoff RA, McCarthy JF. Can "deaths of despair" serve as a focus for planning and evaluating clinical and preventive services for Veterans? Psychiatry Res 2020; 285:112841. [PMID: 32050146 DOI: 10.1016/j.psychres.2020.112841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 10/25/2022]
Abstract
Deaths of despair, a composite outcome including suicide and drug- and alcohol-related deaths, have been increasing, especially in subpopulations and geographic areas sensitive to economic and social hardships. The Veterans Health Administration (VHA) has begun evaluating the utility of this concept to guide planning and evaluations of clinical and preventive services for Veterans. In this study, mortality rates for middle-aged American men for 2013 to 2017 were from CDC WONDER, and rates for all Veterans, those using VHA healthcare services (VHA-utilizers), and other (non-VHA) Veterans were derived from National Death Index data. Findings demonstrated that rates for the composite were higher in VHA-utilizers and lower in non-VHA Veterans than middle-aged American men, consistent with use of VHA services by Veterans with the greatest needs. State rates in Veteran men were significantly and positively correlated with state rates for American men, and both were correlated with other characteristics of the social environment. The lack of correlation between rates for suicide and drug-related deaths indicates that deaths of despair cannot be modeled by assuming parallel paths from reactions to community-based stressors to the component outcomes; models should allow for an impact of community characteristics on partitioning between outcomes.
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Affiliation(s)
- Ira R Katz
- VA Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC 20420, United States.
| | - Kallisse R Dent
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI 48109, United States
| | - Sybil W Morley
- VA Center of Excellence for Suicide Prevention, Canandaigua, NY, 14424, United States
| | - Tyler C Hein
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI 48109, United States
| | - Rani A Hoff
- VA Northeast Program Evaluation Center, West Haven, CT, 06516, United States; Department of Psychiatry, Yale University, New Haven, CT, 06520, United States
| | - John F McCarthy
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI 48109, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, United States
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Affiliation(s)
- Ira R Katz
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Philadelphia, Pennsylvania
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Katz IR, Peltzman T, Jedele JM, McCarthy JF. Critical Periods for Increased Mortality After Discharge From Inpatient Mental Health Units: Opportunities for Prevention. Psychiatr Serv 2019; 70:450-456. [PMID: 30890049 DOI: 10.1176/appi.ps.201800352] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Studies of patients in the U.S. Department of Veterans Affairs (VA) health system and elsewhere have documented elevated mortality from suicide during a critical period within 30 to 90 days after discharge from inpatient mental health units. To support program planning, VA evaluated whether the elevated mortality during this critical period was specific to suicide or whether there were similar increases in other causes of death. METHODS Indicators of age, gender, inpatient diagnoses, and suicide attempts and ideation from VA records were combined with indicators of vital status and cause of death from the National Death Index. Analyses compared all-cause and cause-specific mortality in the first 30 and 90 days postdischarge with mortality in days 91 to 365 after discharge for the 106,430 VA patients discharged from inpatient mental health units in 2013-2014. RESULTS Elevated mortality during the first 30 and first 90 days after discharge was not specific to suicide. Higher rates of all-cause mortality were noted, including elevated mortality due to external causes other than suicide among young and middle-aged patients (ages 18-64) during the first 30 days and among older patients (≥65) during the first 90 days. An increase in natural-cause mortality among older patients was attributable to greater mortality among those with dementia diagnoses. CONCLUSIONS Elevated rates of nonsuicide external-cause mortality in the critical period within 30 to 90 days after discharge from inpatient mental health care suggest important opportunities for prevention. Greater mortality among patients with dementia or related neurodegenerative diseases raises questions regarding current strategies for managing behavioral symptoms and transitions to end-of-life care.
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Affiliation(s)
- Ira R Katz
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA), Philadelphia (Katz); Serious Mental Illness Treatment Resource and Evaluation Center, VA, Ann Arbor, Michigan (Peltzman, Jedele, McCarthy); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy)
| | - Talya Peltzman
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA), Philadelphia (Katz); Serious Mental Illness Treatment Resource and Evaluation Center, VA, Ann Arbor, Michigan (Peltzman, Jedele, McCarthy); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy)
| | - Jenefer M Jedele
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA), Philadelphia (Katz); Serious Mental Illness Treatment Resource and Evaluation Center, VA, Ann Arbor, Michigan (Peltzman, Jedele, McCarthy); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy)
| | - John F McCarthy
- Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA), Philadelphia (Katz); Serious Mental Illness Treatment Resource and Evaluation Center, VA, Ann Arbor, Michigan (Peltzman, Jedele, McCarthy); Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy)
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Kessler RC, Hwang I, Hoffmire CA, McCarthy JF, Petukhova MV, Rosellini AJ, Sampson NA, Schneider AL, Bradley PA, Katz IR, Thompson C, Bossarte RM. Developing a practical suicide risk prediction model for targeting high-risk patients in the Veterans health Administration. Int J Methods Psychiatr Res 2017; 26:e1575. [PMID: 28675617 PMCID: PMC5614864 DOI: 10.1002/mpr.1575] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/25/2017] [Accepted: 05/30/2017] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES The US Veterans Health Administration (VHA) has begun using predictive modeling to identify Veterans at high suicide risk to target care. Initial analyses are reported here. METHODS A penalized logistic regression model was compared with an earlier proof-of-concept logistic model. Exploratory analyses then considered commonly-used machine learning algorithms. Analyses were based on electronic medical records for all 6,360 individuals classified in the National Death Index as having died by suicide in fiscal years 2009-2011 who used VHA services the year of their death or prior year and a 1% probability sample of time-matched VHA service users alive at the index date (n = 2,112,008). RESULTS A penalized logistic model with 61 predictors had sensitivity comparable to the proof-of-concept model (which had 381 predictors) at target thresholds. The machine learning algorithms had relatively similar sensitivities, the highest being for Bayesian additive regression trees, with 10.7% of suicides occurred among the 1.0% of Veterans with highest predicted risk and 28.1% among the 5.0% of with highest predicted risk. CONCLUSIONS Based on these results, VHA is using penalized logistic regression in initial intervention implementation. The paper concludes with a discussion of other practical issues that might be explored to increase model performance.
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Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Claire A Hoffmire
- VISN 19 Mental Illness Research, Education and Clinical Care Center, Denver, Colorado, USA
| | - John F McCarthy
- Office of Mental Health Operations, VA Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, Michigan, USA
| | - Maria V Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony J Rosellini
- Center for Anxiety and Related Disorders, Boston University, Boston, Massachusetts, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra L Schneider
- VISN 19 Mental Illness Research, Education and Clinical Care Center, Denver, Colorado, USA
| | - Paul A Bradley
- PricewaterhouseCoopers PS LLP, Washington, District of Columbia, USA
| | - Ira R Katz
- Office of Mental Health Operations, Veterans Health Administration, Washington, District of Columbia, USA
| | - Caitlin Thompson
- Office of Suicide Prevention, Veterans Health Administration, Washington, District of Columbia, USA.,Department of Psychiatry, University of Rochester, Rochester, New York, USA
| | - Robert M Bossarte
- West Virginia University Injury Control Research Center and Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA.,Office of Suicide Prevention and VISN 2 Center of Excellence for Suicide Prevention, Veterans Health Administration, Washington, District of Columbia, USA
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Bohnert KM, Ilgen MA, Louzon S, McCarthy JF, Katz IR. Substance use disorders and the risk of suicide mortality among men and women in the US Veterans Health Administration. Addiction 2017; 112:1193-1201. [PMID: 28301070 DOI: 10.1111/add.13774] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/08/2016] [Accepted: 01/27/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Limited information is available regarding links between specific substance use disorders (SUDs) and suicide mortality; however, the preliminary evidence that is available suggests that suicide risk associated with SUDs may differ for men and women. This study aimed to estimate associations between SUDs and suicide for men and women receiving Veterans Health Administration (VHA) care. DESIGN A cohort study using national administrative health records. SETTING National VHA system, USA. PARTICIPANTS All VHA users in fiscal year (FY) 2005 who were alive at the beginning of FY 2006 (n = 4 863 086). MEASUREMENTS The primary outcome of suicide mortality was assessed via FY 2006-2011 National Death Index (NDI) records. Current SUD diagnoses were the primary predictors of interest, and were assessed via FY 2004-2005 VHA National Patient Care Database (NPCD) records. FINDINGS In unadjusted analyses, a diagnosis of any current SUD and the specific current diagnoses of alcohol, cocaine, cannabis, opioid, amphetamine and sedative use disorders were all associated significantly with increased risk of suicide for both males and females [hazard ratios (HRs)] ranging from 1.35 for cocaine use disorder to 4.74 for sedative use disorder for men, and 3.89 for cannabis use disorder to 11.36 for sedative use disorder for women]. Further, the HR estimates for the relations between any SUD, alcohol, cocaine and opioid use disorders and suicide were significantly stronger for women than men (P < 0.05). After adjustment for other factors, most notably comorbid psychiatric diagnoses, associations linking SUDs with suicide were attenuated markedly and the greater suicide risk among females was observed for only any SUD and opioid use disorder (P < 0.05). CONCLUSIONS Current substance use disorders (SUDs) signal increased suicide risk, especially among women, and may be important markers to consider including in suicide risk assessment strategies. None the less, other co-occurring psychiatric disorders may partially explain associations between SUDs and suicide, as well as the observed excess suicide risk associated with SUDs among women.
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Affiliation(s)
- Kipling M Bohnert
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Mark A Ilgen
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Samantha Louzon
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Ann Arbor, MI, USA
| | - John F McCarthy
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.,Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Ann Arbor, MI, USA
| | - Ira R Katz
- Department of Veterans Affairs, Office of Mental Health Services, Washington, DC, USA
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Harrington KM, Liang MH, Hannagan K, Thwin SS, Ferguson RE, Morgenstern N, Flores E, Katz IR. Design and conduct of a provider survey to determine a clinically persuasive effect size in planning VA Cooperative Study #590 (Li+). Contemp Clin Trials Commun 2016; 4:149-154. [PMID: 29736478 PMCID: PMC5935897 DOI: 10.1016/j.conctc.2016.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/17/2016] [Accepted: 08/30/2016] [Indexed: 12/02/2022] Open
Abstract
Background The estimation of an effect size is an important step in designing an adequately powered, feasible clinical trial intended to change clinical practice. During the planning phase of VA Cooperative Study #590, “Double-Blind Placebo-Controlled Study of Lithium for Preventing Repeated Suicidal Self-Directed Violence in Patients with Depression or Bipolar Disorder (Li+),” it was not clear what effect size would be considered large enough to influence prescribing behavior among practicing clinicians. Methods We conducted an online survey of VA psychiatrists to assess their interest in the study question, their clinical experience with lithium, and their opinion about what suicide reduction rate would change their prescribing habits. The 9-item survey was hosted on SurveyMonkey© and VA psychiatrists were individually emailed an invitation to complete an anonymous online survey. Three email waves were sent over three weeks. Results Overall, 862 of 2713 VA psychiatrists (response rate = 31.8%) responded to the anonymous survey. 74% of the respondents would refer a patient to the proposed trial, 9% would not, and 17% were unsure. Presented with suicide reduction rates in 10% increments ranging from 10 to 100%, 61% of respondents indicated that they would use lithium if suicide attempts were reduced by at least 40%; 83% would use lithium if it reduced attempts by at least 50%. Conclusions Even with the limitations of response bias and the reliability of responses on future prescribing behavior, a survey of potential users of a clinical trial's results offers a convenient, empirical method for determining and justifying clinically relevant effect sizes.
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Affiliation(s)
- Kelly M Harrington
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Cooperative Studies Program Coordinating Center (CSPCC), Boston, MA, USA
| | - Matthew H Liang
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Cooperative Studies Program Coordinating Center (CSPCC), Boston, MA, USA
| | - Keri Hannagan
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Cooperative Studies Program Coordinating Center (CSPCC), Boston, MA, USA
| | - Soe Soe Thwin
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Cooperative Studies Program Coordinating Center (CSPCC), Boston, MA, USA
| | - Ryan E Ferguson
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Cooperative Studies Program Coordinating Center (CSPCC), Boston, MA, USA
| | - Natalie Morgenstern
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Cooperative Studies Program Coordinating Center (CSPCC), Boston, MA, USA
| | - Erick Flores
- VA Boston Healthcare System, Department of Rheumatology, Boston, MA, USA
| | - Ira R Katz
- Veterans Affairs Office of Mental Health Operations, Washington, DC, USA
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Abstract
OBJECTIVE Frequency of suicidal ideation in the past two weeks, assessed by item 9 of the nine-item Patient Health Questionnaire (PHQ-9), has been positively associated with suicide mortality among patients in a setting other than the Veterans Health Administration (VHA). To inform suicide prevention activities at the VHA, it is important to evaluate whether item 9 is associated with suicide risk among patients in the VHA system. METHODS PHQ-9 assessments (N=447,245) conducted by the VHA between October 1, 2009, and September 30, 2010, were collected. National Death Index data were used to ascertain suicide mortality from the date of PHQ-9 assessment through September 30, 2011. Multivariable proportional hazards regressions were used to evaluate associations between responses to item 9 and suicide mortality. RESULTS After the analyses adjusted for covariates, a response of "several days" for item 9 was associated with a 75% increased risk of suicide (hazard ratio [HR]=1.75, 95% confidence interval [CI]=1.24-2.46), a response of "more than half the days" was associated with a 115% increased risk of suicide (HR=2.15, CI=1.32-3.51), and a response of "nearly every day" was associated with a 185% increased risk of suicide (HR=2.85, CI=1.81-4.47), compared with a response of "not at all." However, 71.6% of suicides during the study period occurred among patients who responded "not at all" to item 9 from their most recent PHQ-9. CONCLUSIONS Higher levels of suicidal ideation, indicated by item 9 of the PHQ-9, were associated with increased risk of suicide among patients in the VHA system.
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Affiliation(s)
- Samantha A Louzon
- Ms. Louzon is with Branch Creative Network, Dearborn, Michigan (e-mail: ). At the time that this work was done, she was with the Office of Mental Health Operations, U.S. Department of Veterans Affairs (VA), Ann Arbor, Michigan, where Dr. McCarthy is affiliated. Dr. Bossarte is with the VA Office of Public Health and Office of Mental Health Services, Rochester, New York. Dr. Katz is with the VA Office of Mental Health Operations, Washington, D.C
| | - Robert Bossarte
- Ms. Louzon is with Branch Creative Network, Dearborn, Michigan (e-mail: ). At the time that this work was done, she was with the Office of Mental Health Operations, U.S. Department of Veterans Affairs (VA), Ann Arbor, Michigan, where Dr. McCarthy is affiliated. Dr. Bossarte is with the VA Office of Public Health and Office of Mental Health Services, Rochester, New York. Dr. Katz is with the VA Office of Mental Health Operations, Washington, D.C
| | - John F McCarthy
- Ms. Louzon is with Branch Creative Network, Dearborn, Michigan (e-mail: ). At the time that this work was done, she was with the Office of Mental Health Operations, U.S. Department of Veterans Affairs (VA), Ann Arbor, Michigan, where Dr. McCarthy is affiliated. Dr. Bossarte is with the VA Office of Public Health and Office of Mental Health Services, Rochester, New York. Dr. Katz is with the VA Office of Mental Health Operations, Washington, D.C
| | - Ira R Katz
- Ms. Louzon is with Branch Creative Network, Dearborn, Michigan (e-mail: ). At the time that this work was done, she was with the Office of Mental Health Operations, U.S. Department of Veterans Affairs (VA), Ann Arbor, Michigan, where Dr. McCarthy is affiliated. Dr. Bossarte is with the VA Office of Public Health and Office of Mental Health Services, Rochester, New York. Dr. Katz is with the VA Office of Mental Health Operations, Washington, D.C
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McCarthy JF, Bossarte RM, Katz IR, Thompson C, Kemp J, Hannemann CM, Nielson C, Schoenbaum M. Predictive Modeling and Concentration of the Risk of Suicide: Implications for Preventive Interventions in the US Department of Veterans Affairs. Am J Public Health 2015; 105:1935-42. [PMID: 26066914 DOI: 10.2105/ajph.2015.302737] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The Veterans Health Administration (VHA) evaluated the use of predictive modeling to identify patients at risk for suicide and to supplement ongoing care with risk-stratified interventions. METHODS Suicide data came from the National Death Index. Predictors were measures from VHA clinical records incorporating patient-months from October 1, 2008, to September 30, 2011, for all suicide decedents and 1% of living patients, divided randomly into development and validation samples. We used data on all patients alive on September 30, 2010, to evaluate predictions of suicide risk over 1 year. RESULTS Modeling demonstrated that suicide rates were 82 and 60 times greater than the rate in the overall sample in the highest 0.01% stratum for calculated risk for the development and validation samples, respectively; 39 and 30 times greater in the highest 0.10%; 14 and 12 times greater in the highest 1.00%; and 6.3 and 5.7 times greater in the highest 5.00%. CONCLUSIONS Predictive modeling can identify high-risk patients who were not identified on clinical grounds. VHA is developing modeling to enhance clinical care and to guide the delivery of preventive interventions.
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Affiliation(s)
- John F McCarthy
- John F. McCarthy and Claire M. Hannemann are with the Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Washington DC. Robert M. Bossarte is with the Epidemiology Program, Office of Public Health; Ira R. Katz is with the Office of Mental Health Operations; Caitlin Thompson is with the Suicide Prevention Program, Mental Health Services; and Christopher Nielson is with Predictive Analytics, Office of Business Intelligence and Analytics, Department of Veterans Affairs. Janet Kemp is with the VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY. Michael Schoenbaum is with the Office of Science Policy, Planning, and Communications, National Institute of Mental Health, Rockville, MD
| | - Robert M Bossarte
- John F. McCarthy and Claire M. Hannemann are with the Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Washington DC. Robert M. Bossarte is with the Epidemiology Program, Office of Public Health; Ira R. Katz is with the Office of Mental Health Operations; Caitlin Thompson is with the Suicide Prevention Program, Mental Health Services; and Christopher Nielson is with Predictive Analytics, Office of Business Intelligence and Analytics, Department of Veterans Affairs. Janet Kemp is with the VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY. Michael Schoenbaum is with the Office of Science Policy, Planning, and Communications, National Institute of Mental Health, Rockville, MD
| | - Ira R Katz
- John F. McCarthy and Claire M. Hannemann are with the Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Washington DC. Robert M. Bossarte is with the Epidemiology Program, Office of Public Health; Ira R. Katz is with the Office of Mental Health Operations; Caitlin Thompson is with the Suicide Prevention Program, Mental Health Services; and Christopher Nielson is with Predictive Analytics, Office of Business Intelligence and Analytics, Department of Veterans Affairs. Janet Kemp is with the VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY. Michael Schoenbaum is with the Office of Science Policy, Planning, and Communications, National Institute of Mental Health, Rockville, MD
| | - Caitlin Thompson
- John F. McCarthy and Claire M. Hannemann are with the Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Washington DC. Robert M. Bossarte is with the Epidemiology Program, Office of Public Health; Ira R. Katz is with the Office of Mental Health Operations; Caitlin Thompson is with the Suicide Prevention Program, Mental Health Services; and Christopher Nielson is with Predictive Analytics, Office of Business Intelligence and Analytics, Department of Veterans Affairs. Janet Kemp is with the VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY. Michael Schoenbaum is with the Office of Science Policy, Planning, and Communications, National Institute of Mental Health, Rockville, MD
| | - Janet Kemp
- John F. McCarthy and Claire M. Hannemann are with the Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Washington DC. Robert M. Bossarte is with the Epidemiology Program, Office of Public Health; Ira R. Katz is with the Office of Mental Health Operations; Caitlin Thompson is with the Suicide Prevention Program, Mental Health Services; and Christopher Nielson is with Predictive Analytics, Office of Business Intelligence and Analytics, Department of Veterans Affairs. Janet Kemp is with the VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY. Michael Schoenbaum is with the Office of Science Policy, Planning, and Communications, National Institute of Mental Health, Rockville, MD
| | - Claire M Hannemann
- John F. McCarthy and Claire M. Hannemann are with the Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Washington DC. Robert M. Bossarte is with the Epidemiology Program, Office of Public Health; Ira R. Katz is with the Office of Mental Health Operations; Caitlin Thompson is with the Suicide Prevention Program, Mental Health Services; and Christopher Nielson is with Predictive Analytics, Office of Business Intelligence and Analytics, Department of Veterans Affairs. Janet Kemp is with the VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY. Michael Schoenbaum is with the Office of Science Policy, Planning, and Communications, National Institute of Mental Health, Rockville, MD
| | - Christopher Nielson
- John F. McCarthy and Claire M. Hannemann are with the Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Washington DC. Robert M. Bossarte is with the Epidemiology Program, Office of Public Health; Ira R. Katz is with the Office of Mental Health Operations; Caitlin Thompson is with the Suicide Prevention Program, Mental Health Services; and Christopher Nielson is with Predictive Analytics, Office of Business Intelligence and Analytics, Department of Veterans Affairs. Janet Kemp is with the VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY. Michael Schoenbaum is with the Office of Science Policy, Planning, and Communications, National Institute of Mental Health, Rockville, MD
| | - Michael Schoenbaum
- John F. McCarthy and Claire M. Hannemann are with the Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Washington DC. Robert M. Bossarte is with the Epidemiology Program, Office of Public Health; Ira R. Katz is with the Office of Mental Health Operations; Caitlin Thompson is with the Suicide Prevention Program, Mental Health Services; and Christopher Nielson is with Predictive Analytics, Office of Business Intelligence and Analytics, Department of Veterans Affairs. Janet Kemp is with the VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY. Michael Schoenbaum is with the Office of Science Policy, Planning, and Communications, National Institute of Mental Health, Rockville, MD
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Conner KR, Bossarte RM, He H, Arora J, Lu N, Tu XM, Katz IR. Posttraumatic stress disorder and suicide in 5.9 million individuals receiving care in the veterans health administration health system. J Affect Disord 2014; 166:1-5. [PMID: 25012403 DOI: 10.1016/j.jad.2014.04.067] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 04/25/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) confers risk for suicidal ideation and suicide attempts but a link with suicide is not yet established. Prior analyses of users of the Veterans health administration (VHA) Health System suggest that other mental disorders strongly influence the association between PTSD and suicide in this population. We examined the association between PTSD and suicide in VHA users, with a focus on the influence of other mental disorders. METHODS Data were based on linkage of VA National Patient Care Database records and the Centers for Disease Control and Prevention׳s National Death Index, with data from fiscal year 2007-2008. Analyses were based on multivariate logistic regression and structural equation models. RESULTS Among users of VHA services studied (N=5,913,648), 0.6% (N=3620) died by suicide, including 423 who had had been diagnosed with PTSD. In unadjusted analysis, PTSD was associated with increased risk for suicide, with odds ratio, OR (95% confidence interval, 95% CI)=1.34 (1.21, 1.48). Similar results were obtained after adjustment for demographic variables and veteran characteristics. After adjustment for multiple other mental disorder diagnoses, PTSD was associated with decreased risk for suicide, OR (95% CI)=0.77 (0.69, 0.86). Major depressive disorder (MDD) had the largest influence on the association between PTSD and suicide. LIMITATIONS The analyses were cross-sectional. VHA users were studied, with unclear relevance to other populations. CONCLUSION The findings suggest the importance of identifying and treating comorbid MDD and other mental disorders in VHA users diagnosed with PTSD in suicide prevention efforts.
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Affiliation(s)
- Kenneth R Conner
- US Department of Veterans Affairs (VA) VISN 2 Center of Excellence for Suicide Prevention, USA; University of Rochester Medical Center, USA.
| | - Robert M Bossarte
- US Department of Veterans Affairs (VA) VISN 2 Center of Excellence for Suicide Prevention, USA; University of Rochester Medical Center, USA
| | - Hua He
- US Department of Veterans Affairs (VA) VISN 2 Center of Excellence for Suicide Prevention, USA; University of Rochester Medical Center, USA
| | - Jyoti Arora
- US Department of Veterans Affairs (VA) VISN 2 Center of Excellence for Suicide Prevention, USA; University of Rochester Medical Center, USA
| | - Naiji Lu
- US Department of Veterans Affairs (VA) VISN 2 Center of Excellence for Suicide Prevention, USA; University of Rochester Medical Center, USA
| | - Xin M Tu
- US Department of Veterans Affairs (VA) VISN 2 Center of Excellence for Suicide Prevention, USA; University of Rochester Medical Center, USA
| | - Ira R Katz
- VA Office of Mental Health Operations, USA
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Olin JT, Schneider LS, Katz IR, Meyers BS, Alexopoulos GS, Breitner JC, Bruce ML, Caine ED, Cummings JL, Devanand DP, Jeste DV, Krishnan KRR, Lyketsos CG, Lyness JM, Rabins PV, III CFR, Rovner BW, Steffens DC, Unützer J, Lebowitz BD. Provisional diagnostic criteria for depression of Alzheimer’s disease: description and review. Expert Rev Neurother 2014; 3:99-106. [DOI: 10.1586/14737175.3.1.99] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bohnert KM, Ilgen MA, McCarthy JF, Ignacio RV, Blow FC, Katz IR. Tobacco use disorder and the risk of suicide mortality. Addiction 2014; 109:155-62. [PMID: 24134689 DOI: 10.1111/add.12381] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 06/25/2013] [Accepted: 10/01/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Tobacco use may be a risk factor for suicide mortality; however, prior research has produced equivocal findings and has been limited by relatively small sample sizes to study the rare event of suicide, as well as a lack of adjustment for other important factors, including psychiatric illness. We estimate the predictive association between tobacco use disorder and the risk of suicide mortality, adjusting for other important variables. DESIGN A prospective cohort study. SETTING The United States Veterans Health Administration (VHA). PARTICIPANTS All individuals who received VHA services in fiscal year (FY) 2005 and were alive at the start of FY 2006 (n = 4 863 086). MEASUREMENTS Tobacco use disorder was assessed via FYs 2004-05 VHA National Patient Care Database records. The outcome of suicide mortality was assessed during the follow-up interval from the beginning of FY 2006 to the end of FY 2008 using National Death Index records. FINDINGS Of the 4 863 086 individuals in the study, 4823 died by suicide during the follow-up interval. In the unadjusted model, tobacco use disorder was associated with an increased risk of suicide [hazard ratio (HR) = 1.88; 95% confidence interval (CI) = 1.76, 2.02]. After adjustment for model covariates, the association remained statistically significant, although attenuated (HR = 1.36, 95% CI = 1.27, 1.46). CONCLUSIONS Tobacco use disorder may confer a modest excess risk of death by suicide. Psychiatric disorders may partially explain the relationship between tobacco use disorder and suicide.
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Affiliation(s)
- Kipling M Bohnert
- VA National Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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McCarthy JF, Ilgen MA, Austin K, Blow FC, Katz IR. Associations between body mass index and suicide in the veterans affairs health system. Obesity (Silver Spring) 2014; 22:269-76. [PMID: 23512622 DOI: 10.1002/oby.20422] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 02/05/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Associations between BMI and suicide risks and methods for individuals receiving care in the Veterans Health Administration (VHA) health system were evaluated. DESIGN AND METHODS For 4,005,640 patients in fiscal years 2001-2002, multivariable survival analyses assessed associations between BMI and suicide, through FY2009. Covariates included demographics, psychiatric, and nonpsychiatric diagnoses, receipt of VHA mental health encounters, and regional network. Among suicide decedents, multivariable Generalized Estimating Equations (GEE) regression examined associations between BMI and suicide method. RESULTS 1.3% of patients were underweight, 24.3% normal weight, 40.6% overweight, and 33.8% obese. Underweight was associated with increased suicide risk (adjusted hazard ratio [AHR] = 1.17, 95% CI: 1.01, 1.36) compared to normal. Overweight and obese status were associated with lower risk (AHR = 0.78, 95% CI: 0.74, 0.82; AHR = 0.63, 95% CI: 0.60, 0.66, respectively). Among suicide decedents, high lethality methods were most common among underweight and least common among obese individuals. Adjusting for covariates, BMI was not associated with method lethality, yet some associations were observed between BMI and specific methods. CONCLUSION Among VHA patients, BMI was negatively associated with suicide risks. These differences may partly relate to choice of suicide method. Low BMI offers an additional resource for clinical suicide risk assessments.
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Affiliation(s)
- John F McCarthy
- US Department of Veterans Affairs (VA), Office of Mental Health Operations (OMHO), Washington, District of Columbia, USA; VA OMHO Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, Michigan, USA; VA Center for Clinical Management Research, Washington, District of Columbia, USA; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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McCarthy JF, Szymanski BR, Karlin BE, Katz IR. Suicide mortality following nursing home discharge in the Department of Veterans Affairs health system. Am J Public Health 2013; 103:2261-6. [PMID: 24134359 DOI: 10.2105/ajph.2013.301292] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed suicide rates up to 6 months following discharge from US Department of Veterans Affairs (VA) nursing homes. METHODS In VA Minimum Data Set (MDS) records, we identified 281 066 live discharges from the 137 VA nursing homes during fiscal years 2002 to 2008. We used MDS and administrative data to assess resident age, gender, behaviors, pain, and indications of psychoses, bipolar disorder, dementia, and depression. We identified vital status and suicide mortality within 6 months of discharge through National Death Index searches. RESULTS Suicide rates within 6 months of discharge were 88.0 per 100 000 person-years for men and 89.4 overall. Standardized mortality ratios relative to age- and gender-matched individuals in the VA patient population were 2.3 for men (95% confidence interval [CI] = 1.9, 2.8) and 2.4 overall (95% CI = 2.0, 2.9). In multivariable proportional hazards regression analyses, resident characteristics, diagnoses, behaviors, and pain were not significantly associated with suicide risk. CONCLUSIONS Suicide risk was elevated following nursing home discharge. This underscores the importance of ongoing VA efforts to enhance discharge planning and timely postdischarge follow-up.
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Affiliation(s)
- John F McCarthy
- John F. McCarthy, Bradley E. Karlin, and Ira R. Katz are with the Department of Veterans Affairs (VA), Washington, DC. John F. McCarthy and Ira R. Katz are also with the VA Office of Mental Health Operations, Washington, DC. Bradley E. Karlin is also with VA Mental Health Services, Washington, DC. Benjamin R. Szymanski is with the Yale School of Public Health, New Haven, CT
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Abstract
IMPORTANCE There are limited data on the extent to which suicide mortality is associated with specific pain conditions. OBJECTIVE To examine the associations between clinical diagnoses of noncancer pain conditions and suicide among individuals receiving services in the Department of Veterans Affairs Healthcare System. DESIGN Retrospective data analysis. SETTING Data were extracted from National Death Index and treatment records from the Department of Veterans Healthcare System. PARTICIPANTS Individuals receiving services in fiscal year 2005 who remained alive at the start of fiscal year 2006 (N = 4 863 086). MAIN OUTCOMES AND MEASURES Analyses examined the association between baseline clinical diagnoses of pain-related conditions (arthritis, back pain, migraine, neuropathy, headache or tension headache, fibromyalgia, and psychogenic pain) and subsequent suicide death (assessed in fiscal years 2006-2008). RESULTS Controlling for demographic and contextual factors (age, sex, and Charlson score), elevated suicide risks were observed for each pain condition except arthritis and neuropathy (hazard ratios ranging from 1.33 [99% CI, 1.22-1.45] for back pain to 2.61 [1.82-3.74] for psychogenic pain). When analyses controlled for concomitant psychiatric conditions, the associations between pain conditions and suicide death were reduced; however, significant associations remained for back pain (hazard ratio, 1.13 [99% CI, 1.03-1.24]), migraine (1.34 [1.02-1.77]), and psychogenic pain (1.58 [1.11-2.26]). CONCLUSIONS AND RELEVANCE There is a need for increased awareness of suicide risk in individuals with certain noncancer pain diagnoses, in particular back pain, migraine, and psychogenic pain.
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Affiliation(s)
- Mark A Ilgen
- Veterans Affairs Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs Healthcare System, Ann Arbor, MI 48109, USA.
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Katz IR, Kemp JE, Blow FC, McCarthy JF, Bossarte RM. Changes in suicide rates and in mental health staffing in the veterans health administration, 2005-2009. Psychiatr Serv 2013; 64:620-5. [PMID: 23494171 DOI: 10.1176/appi.ps.201200253] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Between 2005 and 2009, the Veterans Health Administration (VHA) enhanced its mental health programs and increased outpatient mental health staffing by 52.8%. However, suicide rates among VHA patients remained the same. This study evaluated this finding by examining variability in staffing increases between VHA's 21 regional networks (Veterans Integrated Service Networks) (VISNs) and associations with suicide rates. METHODS Suicide rates among VHA patients were derived from the National Death Index and VHA clinical and administrative records for 2005 and 2009. Comparisons across VISNs used measures of proportional change in mental health staffing (overall and in inpatient, residential, intensive case management, and outpatient programs) and comparable measures of mental health staffing per 1,000 mental health patients. RESULTS Significant correlations were found between proportional changes from 2005 to 2009 in suicide rates and outpatient mental health staffing (r=-.453, p=.039) and outpatient mental health staffing per 1,000 patients (r=-.533, p=.013). The ten VISNs above the median in proportional changes in mental health staffing had average decreases in suicide rates of 12.6% while those below had increases of 11.6% (p=.005). For proportional changes in mental health staffing per 1,000 patients, those above the median had decreases of 11.2% and those below had increases of 13.8% (p=.014). For the average VISN, it would have required a 27.5%-36.8% increase in outpatient staff over 2005 levels to decrease suicide rates by 10%. CONCLUSIONS Mental health enhancements in VHA were associated with decreases in suicide rates in VISNs where the increases in mental health outpatient staffing were greatest.
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Affiliation(s)
- Ira R Katz
- Philadelphia VA Medical Center, University and Woodland Avenues, Philadelphia, PA 19104, USA.
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Abstract
Suicide crisis lines have a respected history as a strategy for reducing deaths from suicide and suicidal behaviors. Until recently, however, evidence of the effectiveness of these crisis lines has been sparse. Studies published during the past decade suggest that crisis lines offer an alternative to populations who may not be willing to engage in treatment through traditional mental health settings. Given this promising evidence, in 2007, the Department of Veterans Affairs in collaboration with the Department of Health and Human Services' Substance Abuse and Mental Health Administration implemented a National Suicide Hotline that is staffed 24 hours a day, 7 days a week, by Veterans Affairs clinical staff. We report here on the implementation of this suicide hotline and our early observations of its utilization in a largely male population.
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Affiliation(s)
- Kerry L Knox
- Department of Veterans Affairs and Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY 14424, USA.
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Katz IR, McCarthy JF, Ignacio RV, Kemp J. Suicide among veterans in 16 states, 2005 to 2008: comparisons between utilizers and nonutilizers of Veterans Health Administration (VHA) services based on data from the National Death Index, the National Violent Death Reporting System, and VHA administrative records. Am J Public Health 2012; 102 Suppl 1:S105-10. [PMID: 22390582 DOI: 10.2105/ajph.2011.300503] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to compare suicide rates among veterans utilizing Veterans Health Administration (VHA) services versus those who did not. METHODS Suicide rates from 2005 to 2008 were estimated for veterans in the 16 states that fully participated in the National Violent Death Reporting System (NVDRS), using data from the National Death Index, NVDRS, and VHA records. RESULTS Between 2005 and 2008, veteran suicide rates differed by age and VHA utilization status. Among men aged 30 years and older, suicide rates were consistently higher among VHA utilizers. However, among men younger than 30 years, rates declined significantly among VHA utilizers while increasing among nonutilizers. Over these years, an increasing proportion of male veterans younger than 30 years received VHA services, and these individuals had a rising prevalence of diagnosed mental health conditions. CONCLUSIONS The higher rates of suicide for utilizers of VHA among veteran men aged 30 and older were consistent with previous reports about which veterans utilize VHA services. The increasing rates of mental health conditions in utilizers younger than 30 years suggested that the decreasing relative rates in this group were related to the care provided, rather than to selective enrollment of those at lower risk for suicide.
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Affiliation(s)
- Ira R Katz
- US Department of Veterans Affairs, Washington, DC, USA
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Bossarte RM, Knox KL, Piegari R, Altieri J, Kemp J, Katz IR. Prevalence and characteristics of suicide ideation and attempts among active military and veteran participants in a national health survey. Am J Public Health 2012; 102 Suppl 1:S38-40. [PMID: 22390598 DOI: 10.2105/ajph.2011.300487] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The relationships between military service and suicide are not clear, and comparatively little is known about the characteristics and correlates of suicide ideation and attempts among those with history of military service. We used data from a national health survey to estimate the prevalence and correlates of suicidal behaviors among veterans and service members in 2 states. The prevalence of suicidal behaviors among Veterans was similar to previous estimates of ideation and attempts among adults in the US general population.
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Affiliation(s)
- Robert M Bossarte
- Veterans Integrated Service Network (VISN) 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY 14424, USA
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Ilgen MA, McCarthy JF, Ignacio RV, Bohnert ASB, Valenstein M, Blow FC, Katz IR. Psychopathology, Iraq and Afghanistan service, and suicide among Veterans Health Administration patients. J Consult Clin Psychol 2012; 80:323-30. [DOI: 10.1037/a0028266] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Katz IR. Mental Health Conditions Among Returning Veterans. Health Aff (Millwood) 2009; 28:1553; author reply 1553-4. [DOI: 10.1377/hlthaff.28.5.1553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ira R. Katz
- Department of Veterans Affairs, Washington, D.C
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Alexopoulos GS, Reynolds CF, Bruce ML, Katz IR, Raue PJ, Mulsant BH, Oslin D, Have TT. Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study. Am J Psychiatry 2009; 166:882-90. [PMID: 19528195 PMCID: PMC2838419 DOI: 10.1176/appi.ajp.2009.08121779] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) evaluated the impact of a care management intervention on suicidal ideation and depression in older primary care patients. This is the first report of outcomes over a 2-year period. METHOD Study participants were patients 60 years of age or older (N=599) with major or minor depression selected after screening 9,072 randomly identified patients of 20 primary care practices randomly assigned to provide either the PROSPECT intervention or usual care. The intervention consisted of services of 15 trained care managers, who offered algorithm-based recommendations to physicians and helped patients with treatment adherence over 24 months. RESULTS Compared with patients receiving usual care, those receiving the intervention had a higher likelihood of receiving antidepressants and/or psychotherapy (84.9%-89% versus 49%-62%) and had a 2.2 times greater decline in suicidal ideation over 24 months. Treatment response occurred earlier on average in the intervention group and increased from months 18 to 24, while no appreciable increase in treatment response occurred in the usual care group during the same period. Among patients with major depression, a greater number achieved remission in the intervention group than in the usual-care group at 4 months (26.6% versus 15.2%), 8 months (36% versus 22.5%), and 24 months (45.4% versus 31.5%). Patients with minor depression had favorable outcomes regardless of treatment assignment. CONCLUSIONS Sustained collaborative care maintains high utilization of depression treatment, reduces suicidal ideation, and improves the outcomes of major depression over 2 years.
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Affiliation(s)
| | | | - Martha L. Bruce
- Department of Psychiatry, Weill Medical College of Cornell University
| | - Ira R. Katz
- Department of Psychiatry, University of Pennsylvania
| | - Patrick J. Raue
- Department of Psychiatry, Weill Medical College of Cornell University
| | | | - David Oslin
- Department of Psychiatry, University of Pennsylvania
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Givens JL, Katz IR, Bellamy S, Holmes WC. Stigma and the acceptability of depression treatments among african americans and whites. J Gen Intern Med 2007; 22:1292-7. [PMID: 17610120 PMCID: PMC2219769 DOI: 10.1007/s11606-007-0276-3] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Revised: 04/05/2007] [Accepted: 06/19/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Stigma is associated with depression treatment, however, whether stigma differs between depression treatment modalities is not known, nor have racial differences in depression treatment stigma been fully explored. OBJECTIVE To measure stigma for four depression treatments and estimate its association with treatment acceptability for African Americans and whites. DESIGN Cross-sectional, anonymous mailed survey. PARTICIPANTS Four hundred and ninety African-American and white primary care patients. MEASUREMENTS The acceptability of four depression treatments (prescription medication, mental health counseling, herbal remedy, and spiritual counseling) was assessed using a vignette. Treatment-specific stigma was evaluated by asking whether participants would: (1) feel ashamed; (2) feel comfortable telling friends and family; (3) feel okay if people in their community knew; and (4) not want people at work to know about each depression treatment. Sociodemographics, depression history, and current depressive symptoms were measured. RESULTS Treatment-specific stigma was lower for herbal remedy than prescription medication or mental health counseling (p < .01). Whites had higher stigma than African Americans for all treatment modalities. In adjusted analyses, stigma relating to self [AOR 0.43 (0.20-0.95)] and friends and family [AOR 0.42 (0.21-0.88)] was associated with lower acceptability of mental health counseling. Stigma did not account for the lower acceptability of prescription medication among African Americans. CONCLUSIONS Treatment associated stigma significantly affects the acceptability of mental health counseling but not prescription medication. Efforts to improve depression treatment utilization might benefit from addressing concerns about stigma of mental health counseling.
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Affiliation(s)
- Jane L Givens
- Boston University Medical Center, Geriatrics Section, Boston, MA 02118-2393, USA.
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