title: Treatment of Veterans with depression who died by suicide: timing and quality of care at last Veterans Health Administration visit.
abstract: OBJECTIVE
  To examine the recency and quality of the last Veterans Health Administration (VHA) visit for patients with depression who died by suicide.
  
  
  METHODS
  We obtained services and pharmacy data for all 1,843 VHA patients with diagnosed depressive disorders (DSM-IV criteria) who died by suicide from April 1999 through September 2004. We ascertained the location and timing of their final VHA visit. For visits occurring within 30 days of suicide, we examined 3 quality indicators: (1) evidence that mental illness was a focus of the final visit, (2) adequacy of antidepressant dosage, and (3) recent receipt of mental health services.
  
  
  RESULTS
  Just over half of the patients (51%) with depression diagnoses had a VHA visit within 30 days of suicide. A minority of these patients (43%) died by suicide within 30 days of a final visit with mental health services, although 64% had received such services within 91 days of their suicide. Among the 57% of patients who died by suicide within 30 days and who were seen in non-mental health settings for their final visit, only 34% had a mental health condition coded at the final visit, and only 41% were receiving adequate dosages of antidepressant (versus 55% for those last seen by mental health services) (P < .0005).
  
  
  CONCLUSIONS
  Veterans Health Administration patients with depression who died by suicide within 30 days of their final visit received relatively high rates of mental health services, but most final visits still occurred in non-mental health settings. Increased referrals to mental health services, attention to mental health issues in non-mental health settings, and focus on antidepressant treatment adequacy by all providers might have reduced suicide risks for these patients.
authors.affiliation: Veterans Health Administration (VHA) Health Services Research and Development Center for Health Quality, Outcomes, and Economic Research, Bedford, Massachusetts, USA. Eric.Smith5@va.gov
authors.forename: Eric G
authors.initials: EG
authors.lastname: Smith
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Craig
authors.forename: Dara
authors.initials: D
authors.lastname: Ganoczy
authors.forename: Heather M
authors.initials: HM
authors.lastname: Walters
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards* / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents