Brady Stephens

Using media to promote suicide prevention hotlines to Veteran households

This article presents preliminary evidence that media campaigns are valuable in promoting suicide prevention hotlines to Veteran households by reporting data from 2526 telephone surveys. Findings from this study underscore the need for further investigation of the use of media campaigns to support suicide prevention initiatives aimed at Veteran populations.

Associations between the Department of Veterans Affairs' suicide prevention campaign and calls to related crisis lines

Objective. The Transit Authority Suicide Prevention (TASP) campaign was launched by the Department of Veterans Affairs (VA) in a limited number of U.S. cities to promote the use of crisis lines among veterans of military service. Methods. We obtained the daily number of calls to the VCL and National Suicide Prevention Lifeline (NSPL) for six implementation cities (where the campaign was active) and four control cities (where there was no TASP campaign messaging) for a 14-month period. To identify changes in call volume associated with campaign implementation, VCL and NSPL daily call counts for three time periods of equal length (pre-campaign, during campaign, and post-campaign) were modeled using a Poisson log-linear regression with inference based on the generalized estimating equations. Results. Statistically significant increases in calls to both the VCL and the NSPL were reported during the TASP campaign in implementation cities, but were not reported in control cities during or following the campaign. Secondary outcome measures were also reported for the VCL and included the percentage of callers who are veterans, and calls resulting in a rescue during the study period. Conclusions. Results from this study reveal some promise for suicide prevention messaging to promote the use of telephone crisis services and contribute to an emerging area of research examining the effects of campaigns on help seeking.

Examining the Intersection Between Suicidal Behaviors and Intimate Partner Violence Among a Sample of Males Receiving Services From the Veterans Health Administration.

Veterans comprise 10% of the population, and suicide among Veterans has garnered national media and policy attention. Existing research suggests that intimate partner violence (IPV) is a risk factor for suicidal behaviors among some high-risk populations. This report offers a new perspective: the intersection between Veterans’ suicidal thoughts and IPV, both victimization and perpetration. The data were obtained from a northeast telephone survey of Veterans (n = 296) using Veterans Health Administration services and yielded a 27% participation rate. Findings suggest male Veterans who are IPV involved have increased odds of suicidal thoughts and behaviors.

VA Suicide Prevention Applications Network: A National Health Care System-Based Suicide Event Tracking System.

Objectives: The US Department of Veterans Affairs’ Suicide Prevention Applications Network (SPAN) is a national system for suicide event tracking and case management. The objective of this study was to assess data on suicide attempts among people using Veterans Health Administration (VHA) services. Methods: We assessed the degree of data overlap on suicide attempters reported in SPAN and the VHA’s medical records from October 1, 2010, to September 30, 2014—overall, by year, and by region. Data on suicide attempters in the VHA’s medical records consisted of diagnoses documented with E95 codes from the International Classification of Diseases, Ninth Revision. Results: Of 50 518 VHA patients who attempted suicide during the 4-year study period, data on fewer than half (41%) were reported in both SPAN and the medical records; nearly 65% of patients whose suicide attempt was recorded in SPAN had no data on attempted suicide in the VHA’s medical records. Conclusion: Evaluation of administrative data suggests that use of SPAN substantially increases the collection of data on suicide attempters as compared with the use of medical records alone, but neither SPAN nor the VHA’s medical records identify all suicide attempters. Further research is needed to better understand the strengths and limitations of both systems and how to best combine information across systems.

Suicide mortality among male veterans discharged from Veterans Health Administration acute psychiatric units from 2005 to 2010

PurposeThe purpose of this study was to calculate suicide rates and identify correlates of risk in the year following discharge from acute Veterans Health Administration psychiatric inpatient units among male veterans discharged from 2005 to 2010 (fiscal years).MethodsSuicide rates and standardized mortality ratios were calculated. Descriptive analyses were used to describe suicides and non-suicides and provide base rates for interpretation, and unadjusted and adjusted proportional hazard models were used to identify correlates of suicide.ResultsFrom 2005 to 2010, 929 male veterans died by suicide in the year after discharge and the suicide rate was 297/100,000 person-years (py). The suicide rate significantly increased from 234/100,000 py (95% CI = 193–282) in 2005 to 340/100,000 py (95% CI = 292–393) in 2008, after which it plateaued. Living in a rural setting, HR (95% CI) = 1.20 (1.05, 1.36), and being diagnosed with a mood disorder such as major depression, HR (95% CI) = 1.60 (1.36, 1.87), or other anxiety disorder, HR (95% CI) = 1.52 (1.24, 1.87), were associated with increased risk for suicide.ConclusionsAmong male veterans, the suicide rate in the year after discharge from acute psychiatric hospitalization increased from 2005 to 2008, after which it plateaued. Prevention efforts should target psychiatrically hospitalized veterans who live in rural settings and/or are diagnosed with mood or other anxiety disorders.

Suicide attempts among alcohol-dependent pain patients before and after an inpatient hospitalization.

BACKGROUND This study examined (1) whether pain diagnoses were risk factors for non-fatal suicide attempts before and after inpatient hospitalizations in alcohol-dependent veterans, and (2) the characteristics of pain patients who attempted suicide. METHOD Administrative data from the Veterans Health Administration were used to identify veterans with an alcohol use disorder who had an inpatient hospitalization during fiscal year 2011 (n=13,047). Logistic regression analyses were used to examine the associations of suicide attempts before and after hospitalizations with pain diagnoses, demographics, medical comorbidity, and psychiatric comorbidity. RESULTS Bivariate analyses and analyses controlling for demographics and medical comorbidity, indicated that pain diagnoses were significantly associated with suicide attempts in the 365days before hospitalization (Odds Ratio Adjusted [OR]=1.22). This effect was not significant after controlling for psychiatric disorders. Pain diagnoses were not identified as risk factors of suicide attempts in the 365days following discharge. Subgroup analyses among only those with a pain diagnosis revealed that being younger (OR=2.64), being female (OR=2.28), and having an attempt in the year prior to hospitalization (OR=4.11) were risk factors of suicide attempts in the year following hospitalization. Additionally, younger age (OR=2.13) and depression (OR=3.53) were associated with attempts in the year prior to the hospitalization. CONCLUSIONS This study suggests that psychiatric disorders account for the relationship between pain diagnoses and past suicide attempts among hospitalized alcohol-dependent veterans. Pain-specific suicide prevention efforts may be better targeted at less intensive levels of care.

Veterans Crisis Line Callers With and Without Prior VHA Service Use

This study examines differences between Veterans with and without prior Veterans Health Administration service use who received a clinical referral from the Veterans’ Crisis Line. Differences between groups were identified using data taken from 13,444 calls and medical records. Approximately 91% of Veterans had a history of service use and 9% did not. Callers with prior service use were older, had more mental health disorders, made in-person contact more quickly, and used more outpatient mental healthcare. Those without prior service use were younger, had more mental health problems, and presented for care later. Callers with suicide-related diagnoses had high rates of service contact. These groups represent different subpopulations with unique healthcare needs and practices.

The Use of Theory-Based Formative Research to Design Suicide Prevention Messaging for U.S. Veterans in Midlife:

Background. Communication campaigns offer a viable mechanism to promote suicide prevention and reinforce mental health for U.S. veterans in midlife, a group with a high suicide burden. However, little empirical investigation of this type of messaging has been conducted, with formative campaign research conspicuously missing from the limited literature. Aims. Using the theory of planned behavior as a guide, formative research was conducted to inform the design of suicide prevention messaging by (a) describing and measuring several theoretical constructs among our audience and (b) modeling associations between constructs and intentions to seek help for suicidal behaviors and mental health more broadly. Methods. Telephone-based cross-sectional surveys were collected between 2014 and 2016 from a nationally representative sample of veterans with analyses restricted to those aged between 44 and 65 years (n = 809). Multiple logistic regression was used to identify significant factors associated with intentions to seek help for either suicidal behaviors or mental health. Results. Perceived behavioral control was one of the largest predictors of intentions to seek help for both suicidal behaviors and mental health concerns. Descriptive norms were also significantly associated with suicide-related intentions. Data further suggest several types of attitudes (i.e., discordant beliefs, stereotypes) to consider when designing messages for this group. Discussion. This study represents one of the first efforts to document and describe theoretical constructs and their influence on intentions among veterans in midlife to contribute to the development of evidence-based messaging for veterans informed by a conceptual framework. Conclusion. Findings have important implications as the use of communication strategies for suicide prevention grows increasingly popular.

Population metrics for suicide events: A causal inference approach

Large-scale public health prevention initiatives and interventions are a very important component to current public health strategies. But evaluating effects of such large-scale prevention/intervention faces a lot of challenges due to confounding effects and heterogeneity of study population. In this paper, we will develop metrics to assess the risk for suicide events based on causal inference framework when the study population is heterogeneous. The proposed metrics deal with the confounding effect by first estimating the risk of suicide events within each of the risk levels, number of prior attempts, and then taking a weighted sum of the conditional probabilities. The metrics provide unbiased estimates of the risk of suicide events. Simulation studies and a real data example will be used to demonstrate the proposed metrics.