PLoS ONE (Jan 2022)

Mental health follow-up and treatment engagement following suicide risk screening in the Veterans Health Administration

  • Nazanin Bahraini,
  • Daniel J. Reis,
  • Bridget B. Matarazzo,
  • Trisha Hostetter,
  • Christina Wade,
  • Lisa A. Brenner

Journal volume & issue
Vol. 17, no. 3

Abstract

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Importance Understanding the extent to which population-level suicide risk screening facilities follow-up and engagement in mental health treatment is important as engaging at-risk individuals in treatment is critical to reducing suicidal behaviors. Objective To evaluate mental health follow-up and treatment engagement in the Veterans Health Administration (VHA) following administration of the Columbia-Suicide Severity Rating Scale (C-SSRS) screen, a component of the VHA’s universal suicide risk screening program. Design This cross-sectional study used data from VA’s Corporate Data Warehouse. Settings 140 VHA Medical Centers. Participants Patients who completed the C-SSRS screen in ambulatory care between October 1, 2018—September 30, 2020. Exposure Standardized suicide risk screening. Main outcomes and measures Mental health follow-up (one or more visits within 30 days of C-SSRS screening) and treatment engagement (two or more visits within 90 days of C-SSRS screening) were examined. Results 97,224 Veterans in Fiscal Year 2019 (FY19) (mean age 51.4 years; 86.8% male; 64.8% white, 22.4% African-American) and 58,693 Veterans in FY20 (mean age 49.6 years; 85.5% male; 63.4% white, 21.9% African-American) received the C-SSRS screen. Across FYs, a positive C-SSRS screen was associated with increased probability of mental health follow-up and treatment engagement. Patients who were not seen in mental health in the year prior to screening had the greatest increase in probability of mental health follow-up and engagement following a positive screen (PConclusions and relevance Identification of suicide risk through population-level screening was associated with increased mental health follow-up and engagement, particularly for non-mental health connected patients. Findings support the use of a standardized, comprehensive suicide risk screening program for managing elevated suicide risk in a large healthcare system.