Linking Public Safety And Public Health Data For Firearm Suicide Prevention In Utah

Barber, Catherine; Berrigan, John; Henn, Morissa; Myers, Kim L.; Staley, Michael J.; Azrael, Deborah; Miller, Matthew; Hemenway, David

doi:10.1377/hlthaff.2019.00618

Cited by 13 publications

(12 citation statements)

References 11 publications

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“…Understanding these patterns can inform future studies that leverage these important data while also pointing toward potentially effective quality improvement efforts. This work is timely given the recent expansion of this important surveillance system to all states and several territories in the U.S. along with increasing efforts to utilize the data for public health practice (e.g., Barber et al, 2019;Nazarov et al, 2019;Ranade et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Behavioral Health Variables in Oregon National Violent Death Reporting System Data: A Linked Cohort Study

Carlson

Gilbert

DeFrancesco

et al. 2022

Preprint

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Background The National Violent Death Reporting System (NVDRS) collects data on the circumstances of violent deaths, and all firearm-related deaths, across states and territories in the United States. This surveillance system is critical to understanding patterns and risk factors for these fatalities, thereby informing targets for prevention. NVDRS variables include behavioral health conditions among decedents, but the validity of the reported behavioral health data is unknown. Using Department of Veterans Affairs (VA) healthcare records as a criterion standard, we examined the accuracy of NVDRS-reported behavioral health variables for veteran decedents in a sample state (Oregon) between 2003 and 2017. Methods We linked Oregon NVDRS data to VA healthcare data to identify veteran decedents who used VA services within two years of death. Veterans’ VA diagnoses within this time frame, including depression, post-traumatic stress disorder (PTSD), anxiety, and substance use disorders, were compared to behavioral health variables identified in the Oregon NVDRS. Concordance, sensitivity, and correlates of sensitivity were examined over time and by decedent characteristics. Results We identified 791 VA-using veterans with fatal injuries documented in the Oregon NVDRS between 2003 and 2017. In this cohort, the Oregon NVDRS accurately identified only 49% of decedents who were diagnosed with depression, 45% of those diagnosed with PTSD, and 17% of those diagnosed with anxiety by the VA. Among 211 veterans diagnosed by the VA with a substance use disorder, the Oregon NVDRS coded only 56% as having a substance use problem. In general, the sensitivity of behavioral health variables in the Oregon NVDRS remained the same or decreased over the study period; however, the sensitivity of PTSD diagnoses increased from 21% in 2003–2005 to 54% in 2015–2017. Sensitivity varied by some decedent characteristics, but not consistently across behavioral health variables. Conclusions NVDRS data from one state missed more than half of behavioral health diagnoses among VA-using veterans who died from violence or from firearm injuries. This suggests that reports of behavioral health conditions among decedents nationally may be severely undercounted. Efforts to improve validity of these variables in state NVDRS data are needed.

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Section: Discussionmentioning

confidence: 99%

Accuracy of Behavioral Health Variables in Oregon National Violent Death Reporting System Data: A Linked Cohort Study

Carlson

Gilbert

DeFrancesco

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Understanding these patterns can inform future studies that leverage these important data while also pointing toward potentially effective quality improvement efforts. This work is timely given the recent expansion of this important surveillance system to all states and several territories in the US along with increasing efforts to utilize the data for public health practice (e.g., Barber et al 2019 ; Nazarov et al 2019 ; Ranade et al 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Accuracy of behavioral health variables in Oregon national violent death reporting system data: a linked cohort study

et al. 2022

View full text Add to dashboard Cite

Background The National Violent Death Reporting System (NVDRS) collects data on the circumstances of violent deaths, and all firearm-related deaths, across states and territories in the USA. This surveillance system is critical to understanding patterns and risk factors for these fatalities, thereby informing targets for prevention. NVDRS variables include behavioral health conditions among decedents, but the validity of the reported behavioral health data is unknown. Using Department of Veterans Affairs (VA) healthcare records as a criterion standard, we examined the accuracy of NVDRS-reported behavioral health variables for veteran decedents in a sample state (Oregon) between 2003 and 2017. Methods We linked Oregon NVDRS data to VA healthcare data to identify veteran decedents who used VA services within two years of death. Veterans’ VA diagnoses within this time frame, including depression, post-traumatic stress disorder (PTSD), anxiety, and substance use disorders, were compared to behavioral health variables identified in the Oregon NVDRS. Concordance, sensitivity, and correlates of sensitivity were examined over time and by decedent characteristics. Results We identified 791 VA-using veterans with violent and/or firearm-related fatal injuries documented in the Oregon NVDRS between 2003 and 2017. In this cohort, the Oregon NVDRS accurately identified only 49% of decedents who were diagnosed with depression, 45% of those diagnosed with PTSD, and 17% of those diagnosed with anxiety by the VA. Among 211 veterans diagnosed by the VA with a substance use disorder, the Oregon NVDRS coded only 56% as having a substance use problem. In general, the sensitivity of behavioral health variables in the Oregon NVDRS remained the same or decreased over the study period; however, the sensitivity of PTSD diagnoses increased from 21% in 2003–2005 to 54% in 2015–2017. Sensitivity varied by some decedent characteristics, but not consistently across behavioral health variables. Conclusions NVDRS data from one state missed more than half of behavioral health diagnoses among VA-using veterans who died from violence or from firearm injuries. This suggests that reports of behavioral health conditions among decedents nationally may be severely undercounted. Efforts to improve validity of these variables in state NVDRS data are needed.

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“…The extent to which using medical records might be used to screen for potential firearm related suicides was assessed in a study that linked suicide data with hospitalization data in the state of Utah. This study, which did not include veteran status, reported that 25% of firearm suicides had been seen in a hospital with a behavioral health diagnosis in the year before their death and only 6% were seen for a suicide attempt or self-harm (Barber et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Risk of suicide among U.S. veterans who deployed as part of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn

Bullman

Schneiderman

2021

Inj. Epidemiol.

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Background There has been concern about the risk of suicide among veterans returning from deployment to Afghanistan and Iraq as part of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND). This study assessed suicide risk among OEF/OIF/OND veterans by gender and unit component. Firearm related suicide was also briefly examined. Findings The study cohort was identified from records of the US Department of Defense. Vital status and cause of death through 2016 was obtained from the Mortality Data Repository, which obtains data from the National Death Index. Suicide risk was first assessed using standardized mortality ratios (SMR)s, comparing the rate of suicide among all veterans, both collectively and separately by gender and unit component (active vs. reserve/National Guard) to the expected based on the US population adjusted for age, race, sex, and calendar year. Risk of suicide among active duty compared to reserve/National Guard veterans and male compared to female veterans was assessed with hazard ratios (HR) s, generated by Cox proportional hazards models, that included the covariates race, age, marital status, rank, and branch of service. There was an increased risk of suicide when all OEF/OIF/OND Veterans were compared to the US population, (SMR = 1.42; 95%, C.I., 1.38,1.46). Both male and female veterans had an increased risk of suicide when compared to their gender specific non-veteran counterparts, (SMR = 1.40; 95%, C.I., 1.36,1.45 and SMR = 1.85; 95%, C.I., 1.60,2.13), respectively. Active duty veterans had an increased risk of suicide compared to reserve/National Guard veterans, (HR = 1.22; 95%, C.I., 1.14,1.30). Male veterans had an almost 3-fold increased risk compared to female veterans, (HR = 2.85; 95%, C.I., 2.47,3.29). Among all veteran suicides 68.3% involved a firearm, including 68.7% among males and 59.5% among females. Conclusions All OEF/OIF/OND veterans have an increased risk of suicide compared to non-veterans. Veterans will benefit from enhanced access to mental health services and initiatives to promote suicide prevention. Strategies that emphasize lethal means safety, an evidence based suicide prevention strategy which includes increasing safe storage practices (i.e., storing firearms unloaded and locked) can help address this increased risk of veteran suicide.

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Linking Public Safety And Public Health Data For Firearm Suicide Prevention In Utah

Cited by 13 publications

References 11 publications

Accuracy of Behavioral Health Variables in Oregon National Violent Death Reporting System Data: A Linked Cohort Study

Accuracy of Behavioral Health Variables in Oregon National Violent Death Reporting System Data: A Linked Cohort Study

Accuracy of behavioral health variables in Oregon national violent death reporting system data: a linked cohort study

Risk of suicide among U.S. veterans who deployed as part of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn

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