Suicide Risk Assessment and Prevention: A Systematic Review Focusing on Veterans

Nelson, Heidi D; Denneson, Lauren M.; Low, Allison; Bauer, Brian W.; O’Neil, Maya; Kansagara, Devan; Teo, Alan R.

doi:10.1176/appi.ps.201600384

Cited by 45 publications

(35 citation statements)

References 74 publications

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“…The mixed results from these primary studies are in line with the results of the reviews included in our rapid overview, as well as reviews conducted in other populations experiencing OSI. Two reviews examining mind and body therapy in military veterans showed improvement in PTSD symptoms and overall health of the participants [78,79], while a recent review of suicide prevention interventions in veterans found inconclusive results leading the study authors to recommend additional exploration using refined methods [80]. The similarity across populations further highlights the need for robust studies to better serve those impacted by OSI.…”

Section: Summary Of Evidencementioning

confidence: 99%

Interventions for the prevention and management of occupational stress injury in first responders: a rapid overview of reviews

et al. 2020

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Background: First responders are a high-risk population for occupational stress injuries as they often encounter prolonged stress within their line of work. The aim of this rapid overview of reviews is to summarize existing evidence on interventions for the prevention and management of occupational stress injury (OSI) in first responders. Methods: MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, and Cochrane Library were searched for systematic reviews examining the impact of prevention, rehabilitation, and resilience-building strategies targeting frontline community safety personnel in February 2019. Pairs of reviewers screened titles and abstracts followed by full-text articles and conducted data abstraction and quality appraisal using the AMSTAR II tool. To ensure a rapid overview process, the search strategy was limited to the last 10 years, quality appraisal of reviews and abstraction of study-level data was completed by one person and verified by another, and the quality of the individual primary studies was not appraised. The findings were summarized descriptively. Results: A total of 14 reviews with 47 unique primary studies were found after screening 1393 records. A majority of studies targeted OSI in police officers (78.7%), followed by firefighters (17%) and correctional officers (4.3%). Of the 47 included primary studies, 24 targeted prevention of OSI (i.e., resilience training, stress management, suicide prevention, and other health promotions) and 23 targeted rehabilitation (i.e., drug therapy, psychotherapy, and other therapies). Prevention strategies including resilience training programs had positive outcomes, while suicide prevention and psychotherapy interventions reported mixed results.

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Section: Summary Of Evidencementioning

confidence: 99%

Interventions for the prevention and management of occupational stress injury in first responders: a rapid overview of reviews

et al. 2020

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“…Cancer October 15, 2018 in 55 cancer centers indicated that less than two-thirds of patients were screened. 57 Furthermore, many physicians may not be comfortable discussing psychosocial issues like suicide with patients or their relatives. 57 Furthermore, many physicians may not be comfortable discussing psychosocial issues like suicide with patients or their relatives.…”

Section: Clinical and Public Health Implicationsmentioning

confidence: 99%

“…52,54,55 The psychosocial literature indicates that screening for psychological distress may be inadequate, 56 and it is particularly difficult to screen for a low-incidence outcome like suicide. 57 Furthermore, many physicians may not be comfortable discussing psychosocial issues like suicide with patients or their relatives. 58 Therefore, although there is a growing consensus around the importance of appropriate assessment and follow-up after a positive distress screen, 59,60 assessing risk for suicide will likely require more time than is available in a routine office visit.…”

Section: Clinical and Public Health Implicationsmentioning

confidence: 99%

Suicide risk among cancer survivors: Head and neck versus other cancers

Osazuwa‐Peters¹,

Zhao

Olomukoro

et al. 2018

Cancer

162

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BACKGROUND: Cancer survivors face psychosocial issues that increase their risk of suicide. This study examined the risk of suicide across cancer sites, with a focus on survivors of head and neck cancer (HNC). METHODS: The Surveillance, Epidemiology, and End Results 18-registry database (from 2000 to 2014) was queried for the top 20 cancer sites in the database, including HNC. The outcome of interest was suicide as a cause of death. The mortality rate from suicide was estimated for HNC sites and was compared with rates for 19 other cancer sites that were included in the study. Poisson regression was used to estimate adjusted rate ratios (aRRs) and 95% confidence intervals (CIs) for 1) HNC versus non-HNC sites (the other 19 cancer sites combined), and 2) HNC versus each individual cancer site. Models were stratified by sex, controlling for race, marital status, age, year, and stage at diagnosis. RESULTS: There were 404 suicides among 151,167 HNC survivors from 2000 to 2014, yielding a suicide rate of 63.4 suicides per 100,000 person-years. In this timeframe, there were 4493 suicides observed among 4219,097 cancer survivors in the study sample, yielding an incidence rate of 23.6 suicides per 100,000 person-years. Compared with survivors of other cancers, survivors of HNC were almost 2 times more likely to die from suicide (aRR, 1.97; 95% CI,). There was a 27% increase in the risk of suicide among HNC survivors during the period from 2010 to 2014 (aRR, 1.27; 95% CI, 1.16-1.38) compared with the period from 2000 to 2004. CONCLUSIONS: Although survival rates in cancer have improved because of improved treatments, the risk of death by suicide remains a problem for cancer survivors, particularly those with HNC. Cancer 2018;124:4072-4079.

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“…The positive predictive value of their model is 6%, which means that 17 individuals would need to receive an intervention to prevent a single suicide attempt. High false-positive rates have been a persistent challenge in screening efforts 6 that have not been overcome by machine learning prediction models. 7 Even in a system willing to invest those resources, the model's sensitivity was only approximately 41%, indicating that nearly 60% of suicide attempts would be missed.…”

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confidence: 99%

Hard Truths About Suicide Prevention

Perlis

Fihn

2020

JAMA Netw Open

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Suicide accounts for nearly 50 000 deaths annually in the US, making it the second leading cause of death among persons 10 to 34 years of age. 1 Although psychiatric illness is associated with elevated rates of death from a range of causes, from cardiovascular disease to cancer, 2 suicide stands out: it occurs precipitously, disproportionately involves younger individuals, and is generally viewed as more preventable. Suicide represents a particular challenge in the military because soldiers are placed in extremely stressful situations, often without adequate physical or emotional support. Their risk remains elevated even after they leave active service and attempt to reenter a society ill-equipped to acknowledge their special needs. For this reason, the US Department of Defense and the US Department of Veterans Affairs (VA) have invested billions of dollars to reduce the incidence of suicide. Every VA secretary for the past 15 years has made suicide prevention a top priority and vowed to eliminate suicide. They have launched initiatives that included hiring more than 400 suicide counselors; establishing hotlines that receive more than 600 000 calls per year; screening patients for depression and posttraumatic stress disorder at nearly 60 million primary care, Author affiliations and article information are listed at the end of this article.

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Suicide Risk Assessment and Prevention: A Systematic Review Focusing on Veterans

Cited by 45 publications

References 74 publications

Interventions for the prevention and management of occupational stress injury in first responders: a rapid overview of reviews

Interventions for the prevention and management of occupational stress injury in first responders: a rapid overview of reviews

Suicide risk among cancer survivors: Head and neck versus other cancers

Hard Truths About Suicide Prevention

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