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

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.