ABSTRACT
BACKGROUND
To reduce suicides among Veterans, the Department of Veterans Affairs (VA) has designated suicide risk assessments for Veterans who screen positive for depression or post-traumatic stress disorder as a national performance goal. Many VA Medical Centers (VAMCs) are using brief suicidal ideation screens, administered in non-mental health ambulatory care settings, as the first step in the assessment process.
OBJECTIVE
To explore Veterans’ perceptions of the suicide screening and risk assessment process, the barriers and facilitators to disclosing suicidal thoughts, and perceptions of possible consequences of revealing suicidal thoughts.
DESIGN
Investigators recorded one semi-structured interview with each Veteran. Transcripts were analyzed using a modified grounded theory approach.
PARTICIPANTS
Thirty-four Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans who screened positive for suicidal ideation in non-mental health ambulatory care settings in 2009 and 2010.
KEY RESULTS
Veterans accepted the need to assess suicide risk. They increasingly experienced attempts to suppress and avoid thoughts of suicide as burdensome and exhausting. Despite this, Veterans often failed to disclose severe and pervasive suicidal thoughts when screened because: (1) they considered suicidal thoughts as shameful and a sign of weakness; (2) they believed suicidal thoughts were private and not to be divulged to strangers; (3) they worried that disclosure would lead to unwanted hospitalization or medication recommendations; and (4) the templated computer reminder process was perceived as perfunctory and disrespectful. In contrast, admitting and discussing thoughts of suicide with a health provider who focused on building a relationship, demonstrated genuineness and empathy, offered information on the rationale for suicide risk assessment, and used straightforward and understandable language, all promoted trust that resulted in more honest disclosure of suicidal thoughts.
CONCLUSION
In ambulatory care settings, both provider behaviors and system modifications may lead to more honest disclosure of suicidal thoughts.
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Acknowledgements
We gratefully acknowledge the assistance of Michael Martin; Megan Crutchfield, MPH; and Monica Huffman, BS. This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, and Health Services Research and Development Service Project DHI-08-096. 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 the United States government.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
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Ganzini, L., Denneson, L.M., Press, N. et al. Trust is the Basis for Effective Suicide Risk Screening and Assessment in Veterans. J GEN INTERN MED 28, 1215–1221 (2013). https://doi.org/10.1007/s11606-013-2412-6
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DOI: https://doi.org/10.1007/s11606-013-2412-6