Review: No definitive standard for identifying and treating veterans at risk for suicide

June 15, 2017

A systematic review of basic and clinical science research has revealed no definitive standard for detecting military veterans at risk of suicidal behavior, nor is there a clear standard of treatment to prevent suicide among U.S. veterans.

The review, conducted by researchers at OHSU and the VA Portland Health Care System in Portland, Oregon, to be published June 15 in the journal Psychiatric Services, comes at a time of increasing public attention to the high rate of suicide among veterans—roughly 20 a day, according to the VA.

"There is currently no definitive screening method for assessing the risk of suicide that would lead to a uniform approach to prevent it," said lead author Heidi D. Nelson, M.D., M.P.H., M.A.C.P., research professor and vice chair of medical informatics and clinical epidemiology in the OHSU School of Medicine and an investigator for the Pacific Northwest Evidence-based Practice Center. "However, this review did shine a light on several promising approaches."

The suicide rate among veterans eclipsed the civilian rate between 2000 and 2010, a time frame that corresponds to the wars in Afghanistan and Iraq. Commissioned by the U.S. Department of Veterans Affairs, the review combed the scientific literature to identify studies published before September 2015 to ascertain the best evidence for detecting and treating among veterans.

The research team evaluated and compared studies that assessed the accuracy of methods to identify individuals at increased risk for suicide and the effectiveness of various interventions in reducing suicide and . They identified a total of 37 studies that were included in the review, many with a focus on U.S. military veterans.

Several screening methods demonstrated fair or better accuracy in identifying patients at risk for suicide, including two based on large administrative data sets and one that employed a self-assessment questionnaire. While various screening methods could identify individuals at risk, they also resulted in high numbers of false alarms.

"It is unclear at this point what level of risk would be needed for a specific method to be clinically useful," Nelson and colleagues wrote. "For example, even with a positive predictive value of 30 percent for , as observed in included studies of high-risk veteran populations, 70 of every 100 cases would be false positives."

The review found that various suicide intervention approaches - such as restricting or delaying access to lethal means such as firearms or medication—were not evaluated in clinical trials, while trials of various therapies were generally inconclusive because the study was inadequately designed to detect differences between treatment approaches or because high-risk patients may have dropped out because of their need for acute care.

"For our veterans with PTSD, depression and related conditions, that can be a very heavy load to carry, especially if the transition from military to civilian life is bumpy," said co-author Alan Teo, M.D., M.S., an assistant professor of psychiatry in the OHSU School of Medicine and the VA Portland Health Care System. "Given the millions of veterans that we are obligated to provide excellent health care for, this study shows all the more reason we need more coordinated research done on prevention. We simply can't let our guard down."

The authors suggest the need for large-scale, multi-site randomized controlled trials.

Explore further: Suicide in veterans – study finds mixed picture

More information: Psychiatric Services (2017). DOI: 10.1176/appi.ps.201600384

Related Stories

Suicide in veterans – study finds mixed picture

May 12, 2017
People who have served in the armed forces do not have a greater risk of suicide overall than people who have never served in the military, but there is an increased risk in certain groups, according to a study by the University ...

Suicide rates increasing for both veterans and nonveterans; veterans using VHA services have declining suicide rates

May 4, 2015
Veterans who used services provided by the Veterans Health Administration (VHA) had much lower suicide rates than veterans who did not use those services, according to a new analysis of a decade of suicide data.

Drug and alcohol problems linked to increased veteran suicide risk, especially in women

March 16, 2017
Veterans who have drug or alcohol problems are more than twice as likely to die by suicide as their comrades, a new study finds. And women veterans with substance use disorders have an even higher rate of suicide—more than ...

Lingering risk of suicide after discharge from psychiatric facilities

May 31, 2017
A study that synthesized more than 50 years of research into suicide rates for patients after discharge from psychiatric facilities suggests the immediate period after discharge was a time of marked risk and that the risk ...

New survey shows PTSD is big problem, even for noncombatants

September 14, 2016
A recent national survey of 1,484 U.S. military veterans shows that posttraumatic stress disorder (PTSD) remains a major health problem, even for service members who have never seen combat. 

Recommended for you

New study rebuts the claim that antidepressants do not work

August 18, 2017
A theory that has gained considerable attention in international media, including Newsweek and the CBS broadcast 60 minutes, suggests that antidepressant drugs such as the SSRIs do not exert any actual antidepressant effect. ...

Should I stay or should I leave? Untangling what goes on when a relationship is being questioned

August 17, 2017
Knowing whether to stay in or leave a romantic relationship is often an agonizing experience and that ambivalence can have negative consequences for health and well-being.

Kids learn moral lessons more effectively from stories with humans than human-like animals

August 17, 2017
A study by researchers at the Ontario Institute for Studies in Education (OISE) at the University of Toronto found that four to six-year-olds shared more after listening to books with human characters than books with anthropomorphic ...

History of stress increases miscarriage risk, says new review

August 17, 2017
A history of exposure to psychological stress can increase the risk of miscarriage by upto 42 per cent, according to a new review.

Study finds children pay close attention to potentially threatening information, avoid eye contact when anxious

August 17, 2017
We spend a lot of time looking at the eyes of others for social cues – it helps us understand a person's emotions, and make decisions about how to respond to them. We also know that adults avoid eye contact when anxious. ...

Communicating in a foreign language takes emotion out of decision making

August 16, 2017
If you could save the lives of five people by pushing another bystander in front of a train to his death, would you do it? And should it make any difference if that choice is presented in a language you speak, but isn't your ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.