MONTREAL — Suicide screening can be done quickly and easily for veterans attending routine primary care visits, according to Hani Shabana, Ph.D., from the Veterans Affairs Medical Center, Salem, Va.
“Primary care is a largely untapped resource” for suicide prevention in this population, he said, noting evidence that many suicides are completed within days of a primary care visit.
“Many veterans are prone to things like chronic pain, post-traumatic stress syndrome, and depression, and there is a push within Veterans Affairs to get mental health providers integrated into the primary care setting,” he said at the annual meeting of the Society of Behavioral Medicine.
Evidence from the Centers for Disease Control and Prevention suggest that up to 20% of all suicides are completed by veterans, a group that is highly trained with guns and that has access to other lethal weapons, he said.
A review of 40 published studies confirms that contact with a primary care provider is much more common than contact with mental health services prior to completed suicide. About 45% of people in the study had visited a primary care provider within one month of their suicide; 20% had seen a mental health specialist.
Older individuals had higher rates of contact with a primary care provider than younger people (Am. J Psychiatry 2002;159:909–16).
An increase in suicide rates among veterans prompted Dr. Shabana's hospital to establish a primary care screening program that captures every veteran at the institution who has not been seen by primary care within the previous two weeks.
At intake, nursing staff ask one simple question: “In the past two weeks have you had urges to harm yourself or others?” A positive answer triggers a thorough assessment with either a primary care or mental health provider at the hospital.
“We assess risk factors, social/demographic factors, current life stressors and protective factors to come up with an overall assessment of whether they are at low, moderate, or high risk for suicide,” he said.
Among a group of veterans who screened positive for the initial intake question, 177 were currently already being seen by a mental health provider, 62 had received mental health treatment previously, and 159 had never been treated.
Data on these veterans showed that 110 were prescribed mental health treatment, 118 were referred to specialty treatment for things such as substance abuse or post-traumatic stress syndrome, 29 were followed by a primary care physician, 31 were followed by a mental health expert, 43 declined help, and 7 were hospitalized.
Among the 118 referred for specialty treatment, 63% had never been offered help before, said Dr. Shabana.
“We are pretty excited about this last group because we are always looking for people who are floating around the system who need help but haven't been getting it.”
The beauty of the screening model is that it is simple and effective, he explained.
There are reduced barriers to access because of the simple hand-off from the intake nurse to a primary care or mental health provider, and there is no obligation to see a mental health expert.
“Some veterans get squeamish about mental health and so for them to have a relationship with their primary care provider is easier, and sometimes helps ease them over to a mental health expert.”