How Do Clinicans Assess Sucide Risk within the Veterans Health Administration? (WITHDRAWN)

Background and Purpose:  Suicide is the 10^th leading cause of death in the United States and Veterans are at a particularly high risk. The latest estimates by the Veterans Health Administration (VHA) are 35.1 deaths per 100,00, which is approximately 22 deaths by suicide per day. In light of these numbers, suicide screening and risk assessment are of utmost importance. To date, very little is known about how clinicians conduct assessments to determine who is at elevated risk for suicide. The purpose of this study was to add to the knowledge base of how clinicians assess suicide risk within the VHA.  Specifically, this study sought to 1) identify factors SPCs consider most important in assessing risk and patient priority; 2) measure the level of consistency and agreement between SPCs in assessing suicide risk and prioritizing cases and; 3) measure individual SPC consistency between cases.

Methods: SPCs (N = 63) responded to online survey questions about imminent and prolonged risk for suicide in response to 30 fictional vignettes. Combinations of twelve acute and chronic suicide risk factors were systematically distributed throughout the 30 vignettes using the Fedorov (1972) procedure. The SPCs were also asked to identify the level of priority for further assessment both disregarding and assuming current caseloads. Data was analyzed using clinical judgment analysis (CJA).

Results: Suicidal plan, β = 1.64; 95% CI (1.45, 1.82), and preparatory behavior, β = 1.40; 95% CI (1.23, 1.57), were considered the most important acute or imminent risk factors by the SPCs. There was less variability across clinicians in the assessment of risk when alcohol use (p=0.02) and hopelessness (p=0.03) were present. When considering acute or imminent risk factors, there was considerable variability between clinicians on a vignette by vignette basis, median SD = 0.86 (range=0.47, 1.13), and within individual clinicians across vignettes, median R2 = 0.80 (0.49, 0.95).

Conclusions and Implications: These findings provide insight into how this group of providers thinks about acute and chronic risk factors contributing to imminent suicide risk in Veterans. The findings highlight which acute factors lead to increases in imminent risk, while the findings are less conclusive about the impact of chronic risk factors. Future research could include the presence of protective factors, such as psychosocial resources and reasons for living. These can have an important influence, and in some instances, reduce the acute risk despite the presence of multiple acute risk factors.