Excerpt

Suicide is a major public health concern in the United States (US), claiming over 36,000 lives each year and nearly 100 lives each day, and suicide among military and Veteran populations is of particular concern. Veterans returning from the Iraq and Afghanistan conflicts, referred to as Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans, may be particularly at risk, although the limited available data has shown mixed results. Several aspects of military experience may increase the risk of suicide, including mental health and substance abuse. Many risk factors specific to the OEF/OIF population have yet to be thoroughly evaluated and incorporated into clinical management.

Ideally, suicide risk assessment tools need to account for the relationship among different risk factors and identify risk factors or combinations of risk factors that are particularly associated with suicidal self-directed violence. To be practically useful, such tools will be brief enough to be conducted in a primary care setting and will identify a threshold beyond which preventive action should be taken. Risk assessment tools should be able to discriminate those at high- and low-risk for suicidal self-directed violence. Likewise, studies of emerging risk factors need to evaluate the contribution of a new potential predictor of suicide and self-directed violence in the context of known risk factors in order to weigh the contribution of the new risk factor against those that are currently known.

The objective of this report is to review recent evidence about risk factors and risk assessment tools within Veteran and military populations to provide evidence for clinical practice guideline development specific to these populations.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • INTRODUCTION
  • METHODS
  • DATA SYNTHESIS
  • PEER REVIEW
  • RESULTS
• INTRODUCTION
  • ANALYTICAL FRAMEWORK AND SCOPE OF THIS REPORT
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • SYSTEMATIC REVIEWS
  • KEY QUESTION #1 What assessment tools are effective for assessing risk of engaging in suicidal self-directed violence in Veteran and military populations?
  • KEY QUESTION #2 In addition to the risk factors included by current assessment tools, what other risk factors predict suicidal self-directed violence in Veteran and military populations?
  • SUMMARY OF FINDINGS
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE BY KEY QUESTION
  • LIMITATIONS
  • RECOMMENDATIONS FOR FUTURE RESEARCH
  • CONCLUSIONS
• REFERENCES
• APPENDIX A SEARCH STRATEGIES
• APPENDIX B STUDY SELECTION FORM
• APPENDIX C CRITERIA USED IN QUALITY ASSESSMENT OF SYSTEMATIC REVIEWS
• APPENDIX D CRITERIA USED IN QUALITY ASSESSMENT OF PRIMARY STUDIES RELATED TO ASSESSING RISK OF ENGAGING IN SUICIDAL SELF-DIRECTED VIOLENCE
• APPENDIX E CRITERIA USED IN QUALITY ASSESSMENT OF PRIMARY STUDIES RELATED TO ADDITIONAL RISK FACTORS TO PREDICT SUICIDAL SELF-DIRECTED VIOLENCE
• APPENDIX F QUALITY RATING OF SYSTEMATIC REVIEWS USING OXMAN AND GUYATT CRITERIA
• APPENDIX G DATA ABSTRACTION FOR PRIMARY STUDIES OBTAINED FROM GOOD QUALITY SYSTEMATIC REVIEWS
• APPENDIX H SUMMARY OF SYSTEMATIC REVIEW RESULTS RELATED TO ASSESSING RISK OF SUICIDE FROM GAYNES ET AL., MANN ET AL., AND NICE REVIEWS
• APPENDIX I DATA ABSTRACTION FOR PRIMARY STUDIES RELATED TO ASSESSING RISK OF ENGAGING IN SUICIDAL SELF-DIRECTED VIOLENCE AMONG MILITARY AND VETERAN POPULATIONS
• APPENDIX J RISK OF BIAS RATINGS FOR PRIMARY STUDIES RELATED TO ASSESSING RISK OF ENGAGING IN SUICIDAL SELF-DIRECTED VIOLENCE AMONG MILITARY AND VETERAN POPULATIONS
• APPENDIX K DATA ABSTRACTION FOR PRIMARY STUDIES OF FACTORS TO PREDICT SUICIDAL SELF-DIRECTED VIOLENCE IN MILITARY AND VETERAN POPULATIONS
• APPENDIX L RISK OF BIAS RATINGS FOR PRIMARY STUDIES OF FACTORS TO PREDICT SUICIDAL SELF-DIRECTED VIOLENCE IN MILITARY AND VETERAN POPULATIONS
• APPENDIX M PEER REVIEW COMMENTS AND AUTHOR RESPONSES
• APPENDIX N ABBREVIATIONS
• APPENDIX O EXCLUDED STUDIES

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Portland VA Medical Center, Portland, OR, Devan Kansagara, M.D., M.C.R., Director

Suggested citation:

Haney EM, O'Neil ME, Carson S, Low A, Peterson K, Denneson LM, Oleksiewicz C, and Kansagara D. Suicide Risk Factors and Risk Assessment Tools: A Systematic Review. VA-ESP Project #05-225; 2012.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Portland VA Medical Center, Portland OR funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.