PhD in Nursing Science Program

Caring for Veterans After a Suicide Attempt: A Description of Behavioral Health Treatment Delivery

Dissertation under the direction of Professor Ann Minnick

Suicide is a serious public health issue that especially affects veterans of the US Armed Forces. Increased risk for suicide is associated with a history of suicide attempt, psychiatric illness, and recent psychiatric hospitalization. Therefore, strategies for suicide prevention recommend timely access to behavioral health treatment after psychiatric hospitalization. Few studies have considered the effect of treatment-related factors in preventing future suicide behavior. This project is concerned with the delivery of behavioral health treatment to veterans who were recently hospitalized for a suicide attempt. In aim one I describe the timing, duration, intensity, provider, setting and modality of post-discharge care during the six months after hospitalization for a suicide attempt. Aim two examines associations of patient and system characteristics with the timing of post-discharge behavioral health treatment.

This retrospective, observational, single cohort study used Veterans Affairs (VA) data, gathered in 2013, in Veterans Integrated Service Network (VISN) 9. Of the 504 veterans in the sample, 31 veterans (6%) experienced a repeat attempt within six months of discharge. Overall, the majority (n=496) of patients attended at least one behavioral health appointment in the six months after discharge. Patients who reattempted suicide received more behavioral health appointments in the first thirty days after discharge, and attended behavioral health appointments earlier than patients who did not reattempt suicide. Certain types of care transitions, e.g. referral to behavioral health services from a medical unit. were associated with differences in the timing of post-discharge care.

Further analyses were limited by the low rate of repeat suicide attempt. Findings may not be generalizable to non-veterans or those veterans who were not admitted to a VA medical center for a suicide attempt. These findings have implications for future research in evaluating the content of care delivered to veterans at high risk of suicide as well as VA data collection and data set formation procedures.