Suicide prevention in US Veterans Mental and Behavioural Disorders
Conditions
Interventions
Current interventions as of 09/02/2022:
Caring Letters is a suicide prevention intervention that is well-suited for a public health approach delivered to a high-risk population. Caring Letters consist
thus inclusion of peer signed notes is based on prior research highlighting the important role of peer support for Veterans.
Each letter will be based on a template with unique messages for each mail
Sponsors
Veterans Crisis Line
Quality Enhancement Research Initiative (QUERI)
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: Current inclusion criteria as of 09/02/2022: Participants will be included if they call the Veterans Crisis Line during the recruitment period (11/06/2020 – 10/06/2021) and: 1. Are an identifiable VCL contact (i.e., not an anonymous contact) 2. Have a valid mailing address on file with the VA 3. Are contacting VCL about themselves (i.e., not contacting VCL about a loved one) All Veterans who complete the initial intervention and contact the VCL again will be considered for the additional Caring Letters. All Veteran age ranges and genders will be included. Previous inclusion criteria: Participants will be included if they call the Veterans Crisis Line during the recruitment period (estimated to be 6/1/2020 – 5/30/2022) and: 1. Are an identifiable VCL caller (i.e. not an anonymous caller) 2. Have a valid mailing address on file with the VA 3. Are calling about themselves (i.e. not calling about a loved one) All veteran age ranges and genders will be included.
Exclusion criteria
Exclusion criteria: Current exclusion criteria as of 09/02/2022: 1. No fixed valid mailing address available in VA records 2. Not identifiable (e.g., full SSN not known; last 4 digits of the SSN and name not available) 3. Not a Veteran (e.g., someone calling on behalf of a Veteran) 4. Has not received Veterans Health Administration (VHA) care Previous exclusion criteria: 1. No fixed valid mailing address available in VA records 2. Not identifiable (e.g. full SSN not known; last 4 digits of the SNN and name not available) 3. Not a veteran (e.g. someone calling on behalf of a veteran) 4. Has not received Veterans Health Administration (VHA) care 5. The intervention is thought to be counter-productive to clinical goals (e.g. poor boundaries with VCL staff)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Suicide attempts, as measured by a record of a suicide attempts 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. | — |
Secondary
| Measure | Time frame |
|---|---|
| Current secondary outcome measures as of 09/02/2022: 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 during Caring Letters and 2 years pre-intervention 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 during Caring Letters and 2 years pre-intervention 3. Rates of outpatient VA mental health care utilization from analysis of VA health care record data from the CDW assessed for 1 year during Caring Letters and 2 years pre-intervention 4. 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 Caring Letters and 2 years pre-intervention 5. Rates of calls to the VCL and VA411 (help line included in the Caring Letters) assessed for 1 year during Caring Letters and 2 years pre-intervention 6. 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 Caring Letters and 2 years pre-intervention. Since these data are not available until about 2 years after the year of death, these results will be delayed compared to other analyses. 7. Measures described in 1-6 above will also be compared between Veterans who contact the VCL again and receive additional Caring Letters, and Veterans who contact the VCL again and do not receive the additional Caring Letters. A secondary goal for this study is to collect data on the delivery of the intervention to inform potential improvements for implementation. The project will assess facilitators and barriers to implementing the Caring Letters program and will include budget impact analyses. The RE-AIM analytic framework will be used to examine implementation and impact of the in | — |
Countries
United States of America
Contacts
Public ContactMark Reger
Outcome results
None listed