Abstract
This national, observational study examined factors associated with undetermined self-directed violence (SDV) classification among Veterans with a SDV event classified as either “suicide attempt” or “undetermined SDV” in in the Veterans Health Administration (VHA) between 2013 and 2018 (N = 55,878). Generalized estimating equations were used to examine associations of patient and SDV event factors with likelihood of an undetermined SDV classification. Veterans who used poisoning or other methods had 1.52 (95%CI: 1.38, 1.66) and 2.33 (95%CI: 2.16, 2.50) increased odds of having their SDV classified as undetermined, respectively. Veterans with a prior year substance use disorder diagnosis had 1.19 (95%CI: 1.14, 1.24) increased odds of having their SDV classified as undetermined. In sex-stratified analyses, associations of poisoning and substance use disorders held only among males. Additional clinical evaluation of patients with histories of substance use disorders or who use poisoning as method of SDV may be warranted when making SDV determinations.
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Acknowledgements
This material is based upon work supported by the United States Department of Veterans Affairs, Veterans Health Administration, VA Health Services Research & Development (HSR&D) project IIR17-131, a VA HSR&D Center to Improve Veteran Involvement in Care locally initiated project grant, and the resources and use of facilities at the VA Portland Health Care System. Dr. Chen’s time is also supported by a VA HSR&D Career Development Award (CDA 18–185). Dr. Denneson is a core investigator at the VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC). We would also like to acknowledge the contribution of Meike Niederhausen, PhD who provided conceptual feedback on an earlier stage of this study and Allison C. O’Neil, MPH who took primary lead on data extraction for our variables of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or United States government.
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All authors contributed to the study conception and design. Data acquisition was performed by Jason Chen and analysis conducted by David Cameron. The first draft of the manuscript was written by Lauren Denneson and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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This observational study was determined to be exempt from ethical approval by the Institutional Review Board where the study took place.
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Denneson, L.M., Cameron, D.C., Hooker, E.R. et al. Self-Directed Violence Surveillance in the Veterans Health Administration: A National Examination of Factors Associated with Undetermined Versus Suicide Attempt Classification. Community Ment Health J 59, 954–961 (2023). https://doi.org/10.1007/s10597-022-01079-6
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DOI: https://doi.org/10.1007/s10597-022-01079-6