TY - JOUR
T1 - Suicide risk assessment and prevention
T2 - A systematic review focusing on veterans
AU - Nelson, Heidi D.
AU - Denneson, Lauren M.
AU - Low, Allison R.
AU - Bauer, Brian W.
AU - O'Neil, Maya
AU - Kansagara, Devan
AU - Teo, Alan R.
N1 - Funding Information:
Dr. Nelson and Dr. Kansagara are with the Department of Medical Informatics and Clinical Epidemiology and Dr. Denneson, Dr. O’Neil, and Dr. Teo are with the Department of Psychiatry, all in the School of Medicine at Oregon Health and Science University, Portland. Dr. Denneson, Dr. O’Neil, Dr. Kansagara, and Dr. Teo are also with the Center to Improve Veteran Involvement in Care, Portland Department of Veterans Affairs Medical Center, Portland, Oregon, where Ms. Low is affiliated. Mr. Bauer is with the Department of Psychology, University of Southern Mississippi, Hattiesburg. Send correspondence to Dr. Teo (e-mail: teoa@ohsu.edu). This work was funded by the Quality Enhancement Research Initiative, Office of Research and Development, Veterans Health Administration (VHA), U.S. Department of Veterans Affairs. Dr. O’Neil’s work was supported in part by PCOR K12 award 1 K12 HS019456 01 from the Agency for Healthcare Research and Quality. Dr. Teo’s work was supported in part by career development award CDA 14-428 from the VHA’s Health Service Research and Development. The U.S. Department of Veterans Affairs had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. The findings and conclusions reported here are those of the authors, who are responsible for its contents, and do not necessarily represent the views of the U.S. Department of Veterans Affairs or the U.S. government. No statement in this article should be construed as an official position of the U.S. Department of Veterans Affairs. The authors report no financial relationships with commercial interests. Received August 19, 2016; revisions received December 14, 2016, and January 31, 2017; accepted March 10, 2017; published online June 15, 2017.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Objective: Suicide rates in veteran and military populations in the United States are high. This article reviews studies of the accuracy of methods to identify individuals at increased risk of suicide and the effectiveness and adverse effects of health care interventions relevant to U.S. veteran and military populations in reducing suicide and suicide attempts. Methods: Trials, observational studies, and systematic reviews relevant to U.S. veterans and military personnel were identified in searches of MEDLINE, PsycINFO, SocINDEX, and Cochrane databases (January 1, 2008, to September 11, 2015), on Web sites, and in reference lists. Investigators extracted and confirmed data and dual-rated risk of bias for included studies. Results: Nineteen studies evaluated accuracy of risk assessment methods, including models using retrospective electronic records data and clinician- or patient-rated instruments. Most methods demonstrated sensitivity $80% or area-under-the-curve values $.70 in single studies, including two studies based on electronic records of veterans and military personnel, but specificity varied. Suicide rates were reduced in six of eight observational studies of populationlevel interventions. Only two of ten trials of individual-level psychotherapy reported statistically significant differences between treatment and usual care. Conclusions: Risk assessment methods have been shown to be sensitive predictors of suicide and suicide attempts, but the frequency of false positives limits their clinical utility. Research to refine these methods and examine clinical applications is needed. Studies of suicide prevention interventions are inconclusive; trials of population-level interventions and promising therapies are required to support their clinical use.
AB - Objective: Suicide rates in veteran and military populations in the United States are high. This article reviews studies of the accuracy of methods to identify individuals at increased risk of suicide and the effectiveness and adverse effects of health care interventions relevant to U.S. veteran and military populations in reducing suicide and suicide attempts. Methods: Trials, observational studies, and systematic reviews relevant to U.S. veterans and military personnel were identified in searches of MEDLINE, PsycINFO, SocINDEX, and Cochrane databases (January 1, 2008, to September 11, 2015), on Web sites, and in reference lists. Investigators extracted and confirmed data and dual-rated risk of bias for included studies. Results: Nineteen studies evaluated accuracy of risk assessment methods, including models using retrospective electronic records data and clinician- or patient-rated instruments. Most methods demonstrated sensitivity $80% or area-under-the-curve values $.70 in single studies, including two studies based on electronic records of veterans and military personnel, but specificity varied. Suicide rates were reduced in six of eight observational studies of populationlevel interventions. Only two of ten trials of individual-level psychotherapy reported statistically significant differences between treatment and usual care. Conclusions: Risk assessment methods have been shown to be sensitive predictors of suicide and suicide attempts, but the frequency of false positives limits their clinical utility. Research to refine these methods and examine clinical applications is needed. Studies of suicide prevention interventions are inconclusive; trials of population-level interventions and promising therapies are required to support their clinical use.
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U2 - 10.1176/appi.ps.201600384
DO - 10.1176/appi.ps.201600384
M3 - Review article
C2 - 28617209
AN - SCOPUS:85030645187
SN - 1075-2730
VL - 68
SP - 1003
EP - 1015
JO - Psychiatric Services
JF - Psychiatric Services
IS - 10
ER -