BACKGROUND: The highest risk for suicide occurs immediately after psychiatric discharge. The U.S. Department of Veteran’s Affairs’ (VA) suicide prevention program emphasizes suicide surveillance and frequent contact after suicide attempt. OBJECTIVES: To describe the 6-month reattempt rate and appointment characteristics for veterans after VA hospitalization for suicide attempt. DESIGN: This retrospective observational study identified veterans hospitalized for suicide attempt (N = 504). Comparisons of patient characteristics and treatment delivery were conducted between veteran groups. RESULTS: The sample (N = 504) was predominantly White (82%) and male (91%), with a median age of 50 years. The 6-month reattempt rate was 6%. Timing of first appointment was earlier in the reattempt group (n = 20) versus the no-reattempt group (n = 467). Appointment intensity, especially telephone appointments, was greater in the reattempt group. CONCLUSION: The effect of postdischarge treatment on preventing suicide cannot be determined by evaluating only treatment timing and intensity. Future studies should measure the treatment quality and clinical severity.
ApplebyL.ShawJ.AmosT.McDonnellR. (1999). Suicide within 12 months of contact with mental health services: National clinical survey. British Medical Journal, 318, 1235-1239. doi:http://dx.doi.org/10.1136/bmj.318.7193.1235
2.
BickleyH.HuntI. M.WindfuhrK.ShawJ.ApplebyL.KapurN. (2013). Suicide within two weeks of discharge from psychiatric inpatient care: A case-control study. Psychiatric Services, 64, 653-659. doi:10.1176/appi.ps.201200026
3.
BrennerL.IgnacioR.BlowF. (2011). Suicide and traumatic brain injury among individuals seeking veterans health administration services. Journal of Head Trauma Rehabilitation, 26, 257-264. doi:10.1097/HTR.0b013e31821fdb6e
4.
BreslauN.SchultzL.LiptonR.PetersonE.WelchK. M. A. (2012). Migraine headaches and suicide attempt. Headache, 52, 723-731. doi:10.1111/j.1526-4610.2012.02117.x
5.
CoffeyC. E. (2007). Building a system of perfect depression care in behavioral health. Joint Commission Journal on Quality and Patient Safety, 33, 193-199.
DesaiR. ADauseyD. J.RosenheckR. A. (2005). Mental health service delivery and suicide risk: the role of individual patient and facility factors. American Journal of Psychiatry, 162, 311-318. doi:10.1176/appi.ajp.162.2.311
8.
ElixhauserASteinerC.HarrisD. R.CoffeyR. M. (1998). Comorbidity measures for use with administrative data. Medical Care, 36, 8-27. doi:10.1097/00005650-199801000-00004
9.
GianniniM. J.BergmarkB.KreshoverS.EliasE.PlummerC.O’KeefeE. (2010). Understanding suicide and disability through three major disabling conditions: Intellectual disability, spinal cord injury, and multiple sclerosis. Disability and Health Journal, 3(2), 74-78. doi:10.1016/j.dhjo.2009.09.001
10.
HuffE. D. (2000). Outpatient utilization patterns and quality outcomes after first acute episode of mental health hospitalization: Is some better than none, and is more service associated with better outcomes?Evaluation & the Health Professions, 23, 441-456. doi:10.1177/01632780022034714
11.
HuntI. M.KapurN.WebbR.RobinsonJ.BurnsJ.ShawJ.ApplebyL. (2009). Suicide in recently discharged psychiatric patients: A case-control study. Psychological Medicine, 39, 443-449. doi:10.1017/S0033291708003644
12.
IlgenM. AZivinK.AustinK. L.BohnertA. S. B.CzyzE. K.ValensteinM.KilbourneA. M. (2010). Severe pain predicts greater likelihood of subsequent suicide. Suicide and Life-Threatening Behavior, 40, 597-608. doi:10.1521/suli.2010.40.6.597
13.
KaneR. L. (2006). Understanding health care outcomes research (2nd ed.). Sudbury, MA: Jones & Bartlett.
14.
KapurN.CooperJ.BennewithO.GunnellD.HawtonK. (2010). Postcards, green cards and telephone calls: Therapeutic contact with individuals following self-harm. The British Journal of Psychiatry, 197, 5-7. doi:10.1192/bjp.bp.109.072496
15.
KatzI. (2012). Lessons learned from mental health enhancement and suicide prevention activities in the veterans health administration. American Journal of Public Health, 102, 2010-2012. doi:10.2105/AJPH.2011.300582
KnesperD. J., American Association of Suicidology, & Suicide Prevention Resource Center. (2010). Continuity of care for suicide prevention and research: Suicide attempts and suicide deaths subsequent to discharge from the emergency department or psychiatry inpatient unit. Newton, MA: Education Development Center.
18.
LuxtonD. D.JuneJ. D.ComtoisK. A. (2013). Can postdischarge follow-up contacts prevent suicide and suicidal behavior? A review of the evidence. Crisis, 34, 32-41. doi:10.1027/0227-5910/a000158
19.
LuxtonD. D.TrofimovichL.ClarkL. L. (2013). Suicide risk among U.S. service members after psychiatric hospitalization, 2001-2011. Psychiatric Services, 64, 626-629. doi:10.1176/appi.ps.201200413.
20.
MoscickiE. K. (1997). Identification of suicide risk factors using epidemiologic studies. Psychiatric Clinics of North America, 20, 499-517. doi:10.1016/S0193-953X(05)70327-0
21.
OwensD.HorrocksJ.HouseA. (2002). Fatal and non-fatal repetition of self-harm: Systematic review. British Journal of Psychiatry, 181, 193-199. doi:10.1192/bjp.181.3.193
22.
SloanK. L.Montez-RathM. E.SpiroA.ChristiansenC. L.LovelandS.ShokeenP.. . . RosenA. K. (2006). Development and validation of a psychiatric case-mix system. Medical Care, 44, 568-580. doi:10.1097/01.mlr.0000215819.76050.a1
23.
VA Information Resource Center. (2011). VHA Medical SAS outpatient datasets and inpatient encounters dataset FY2009: VIReC research user guide. Hines, IL: Department of Veterans Affairs, Health Services Research and Development Service, VA Information Resource Center.
24.
ValensteinM.KimH. M.GanoczyD.McCarthyJ. F.ZivinK.AustinK. L.. . . OlfsonM. (2009). Higher-risk periods for suicide among VA patients receiving depression treatment: prioritizing suicide prevention efforts. Journal of Affective Disorders, 112(1-3), 50-58. doi:10.1016/j.jad.2008.08.020
25.
YimP. S.YipP. S.LiR. H.DunnE. L.YeungW. S.MiaoY. K. (2004). Suicide after discharge from psychiatric inpatient care: A case-control study in Hong Kong. Australian and New Zealand Journal of Psychiatry, 38, 65-72. doi:10.1111/j.1440-1614.2004.01299.x
