Suicide prevention in US Veterans Other
Conditions
Interventions
Caring Letters is a suicide prevention intervention that is well-suited for a high-risk population. Caring Letters consist of simple expressions of care and support sent through the mail. Caring Lette
Sponsors
Veterans Crisis Line
Quality Enhancement Research Initiative
Eligibility
Sex/Gender
All
Age
18 Years to 110 Years
Inclusion criteria
Inclusion criteria: Participants will be included in the Centralized Caring Letters intervention if they have an inactivated High Risk for Suicide Patient Record Flag (HRS PRF) during the recruitment period which is 30/6/2023 – 29/06/2024 for phase 1 sites and 31/1/2024 – 29/06/2024 for phase 2 sites and: 1. Have a valid mailing address on file with the VHA 2. Are not removed or opted out by a local Suicide Prevention Coordinator prior to enrollment in the intervention. 3. Have not died before upload of their name and address information for mail processing 4. Are not actively enrolled in and receiving Caring Letters from the Veterans Crisis Line Caring Letter project at the time of eligibility for enrollment All Veteran age ranges and genders will be included.
Exclusion criteria
Exclusion criteria: 1. No fixed valid mailing address available in VHA records 2. Death prior to upload of name and address information for mail processing 3. Actively enrolled in and receiving Caring Letters from the Veterans Crisis Line Caring Letter project at the time of eligibility for enrollment
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1. Incidence and frequency of VA psychiatric hospitalization from analysis of VA health care records data obtained from the VA’s Corporate data Warehouse (CDW) assessed for 1 year of Centralized Caring Letters delivery and in a pre-intervention comparison cohort 2. Incidence and frequency of VA emergency department visits obtained from analysis of VA health care record data from the CDW assessed for 1 year of Centralized Caring Letters and in a pre-intervention comparison cohort 3. Rates of outpatient VA mental health care utilization from analysis of VA health care record data from the CDW assessed for 1 year of Caring Letters and in a pre-intervention comparison cohort | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Incidence of any outpatient care, and any inpatient care obtained from analyses of VA health care record data from the CDW assessed for 1 year of Caring Letters and in a pre-intervention comparison cohort. 2. Suicide attempts, as measured by a record of a suicide-related event in VA suicide behavior surveillance data (reports submitted by VA providers) or ICD-10 codes during the 1-year receipt of Caring Letters. A record of a suicide attempt in either data source will indicate that the case is positive for a suicide attempt. ICD-10 codes that will be considered a suicide attempt include those associated with intentional poisoning and other intentional self-harm assessed for 1 year during Centralized Caring Letters delivery and in a pre-intervention comparison cohort. 3. All-cause mortality, i.e., death rate from all causes of death obtained from VA health care record data from the CDW assessed for 1 year during Centralized Caring Letters delivery and in a pre-intervention comparison cohort of. 4. Rates of suicide: Suicide mortality rates will be obtained from the VA/DoD Mortality Data Repository which contains the National Death Index (state death records data) for all Veterans assessed for 1 year during Centralized Caring Letters and in a pre-intervention comparison cohort. Since these data are not available until about 2 years after the year of death, these results will be delayed compared to other analyses. 5. A secondary goal for this study is to collect data on the delivery of the intervention and the role of the implementation strategy of centralizing the program delivery. Differences in reach in the centralized versus decentralized Caring Letters approaches will be assessed using administrative data. Fidelity to the centralized Caring Letters approach will be assessed using administrative data. The RE-AIM analytic framework will be used to examine implementation and impact of the intervention. Data from qualitative interviews with Veteran participants (N=3 | — |
Countries
Puerto Rico, United States of America
Outcome results
None listed