Online Program

Trust is the basis for effective assessment for suicidal ideation in veterans

Wednesday, November 6, 2013 : 11:00 a.m. - 11:15 a.m.

Steven Dobscha, MD, Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR
The VA has established conducting brief structured assessments for suicidal ideation (SI) following positive depression screens as a national performance measure. The goal of this qualitative study was to explore Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans' experiences and perceptions regarding the structured SI risk assessment process. Qualitative interviews were completed with 34 OEF/OIF Veterans from three VA Medical Centers who had positive assessments for SI. Veterans were asked about their experiences and perceptions of the process including memories, feelings, comfort, and honesty. Data were analyzed using the constant comparative method. Many OIF/OEF Veterans were accustomed to being asked about suicidal thoughts, and they described assessment questions as straightforward and understandable. Most Veterans accepted the value of screening for disease in general, but some wondered if suicidal ideation was too sensitive and serious for standardized assessment. They worried that admitting suicidal thoughts might lead to overreaction by providers or counter-therapeutic hospitalization. Some expressed negative, stigmatizing views of being suicidal as evidence of weakness or failing. Many Veterans confessed they had not been previously honest in response to SI assessment questions, and reported that they were untruthful if the assessments were completed in a perfunctory manner, read off computer screens, or not integrated into care. Candid discussion of suicidal thoughts was enhanced when administered by trusted providers who communicated genuine concern. Accurate assessment of the presence and severity of SI may be improved if integrated into care with ongoing providers with whom the Veteran has developed trust.

Learning Areas:

Clinical medicine applied in public health
Public health or related research

Learning Objectives:
Describe patient experiences following a suicide screen. Identify factors associated with positive clinical interactions. Discuss recommendations for improved assessment of suicide risk.

Keyword(s): Mental Health Services, Suicide

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a licensed psychiatrist and experienced mental health services researcher specialized in assessment of suicide risk.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.