title: Primary care clinician responses to positive suicidal ideation risk assessments in veterans of Iraq and Afghanistan.
abstract: OBJECTIVE
  To examine primary care clinician actions following positive suicide risk assessments administered to Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans.
  
  
  METHODS
  We identified OEF/OIF veterans with positive templated suicide risk assessments administered in primary care settings of three Veterans Affairs (VA) Medical Centers. National VA datasets and manual record review were used to identify and code clinician discussions and actions following positive assessments. Bivariate analyses were used to examine relationships between patient characteristics and discussions of firearms access and alcohol/drug use.
  
  
  RESULTS
  Primary care clinicians documented awareness of suicide risk assessment results for 157 of 199 (79%) patients with positive assessments. Most patients were assessed for mental health conditions and referred for mental health follow-up. Clinicians documented discussions about firearms access for only 15% of patients. Among patients whose clinicians assessed for substance abuse, 34% received recommendations to reduce alcohol or drug use. Depression diagnoses and suicidal ideation/behavior severity were significantly associated with firearms access discussions, while patient sex, military service branch, and substance abuse diagnoses were significantly associated with recommendations to reduce substance use.
  
  
  CONCLUSIONS
  Greater efforts are needed to understand barriers to clinicians' assessing, documenting and counseling once suicidal ideation is detected, and to develop training programs and systems changes to address these barriers.
authors.affiliation: VA HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland Veterans Affairs Medical Center, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA. Electronic address: steven.dobscha@va.gov.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
authors.affiliation: VA HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland Veterans Affairs Medical Center, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Denneson
authors.affiliation: VA HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland Veterans Affairs Medical Center, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Kovas
authors.affiliation: VA HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland Veterans Affairs Medical Center, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Corson
authors.affiliation: War-Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA; Rutgers University, New Jersey Medical School, Newark, NJ, USA.
authors.forename: Drew A
authors.initials: DA
authors.lastname: Helmer
authors.affiliation: Richard L. Roudebush Veteran Affairs Medical Center, Indianapolis, IN, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bair
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D003863:Depression / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D058007:Physicians, Primary Care / Q000592:standards*; D018570:Risk Assessment; D059020:Suicidal Ideation; D014481:United States; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: Depression; Screening; Suicide; Veterans