title: Predictive Modeling and Concentration of the Risk of Suicide: Implications for Preventive Interventions in the US Department of Veterans Affairs.
abstract: OBJECTIVE
  The Veterans Health Administration (VHA) evaluated the use of predictive modeling to identify patients at risk for suicide and to supplement ongoing care with risk-stratified interventions.
  
  
  METHODS
  Suicide data came from the National Death Index. Predictors were measures from VHA clinical records incorporating patient-months from October 1, 2008, to September 30, 2011, for all suicide decedents and 1% of living patients, divided randomly into development and validation samples. We used data on all patients alive on September 30, 2010, to evaluate predictions of suicide risk over 1 year.
  
  
  RESULTS
  Modeling demonstrated that suicide rates were 82 and 60 times greater than the rate in the overall sample in the highest 0.01% stratum for calculated risk for the development and validation samples, respectively; 39 and 30 times greater in the highest 0.10%; 14 and 12 times greater in the highest 1.00%; and 6.3 and 5.7 times greater in the highest 5.00%.
  
  
  CONCLUSIONS
  Predictive modeling can identify high-risk patients who were not identified on clinical grounds. VHA is developing modeling to enhance clinical care and to guide the delivery of preventive interventions.
authors.affiliation: John F. McCarthy and Claire M. Hannemann are with the Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Washington DC. Robert M. Bossarte is with the Epidemiology Program, Office of Public Health; Ira R. Katz is with the Office of Mental Health Operations; Caitlin Thompson is with the Suicide Prevention Program, Mental Health Services; and Christopher Nielson is with Predictive Analytics, Office of Business Intelligence and Analytics, Department of Veterans Affairs. Janet Kemp is with the VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY. Michael Schoenbaum is with the Office of Science Policy, Planning, and Communications, National Institute of Mental Health, Rockville, MD.
authors.forename: John F
authors.initials: JF
authors.lastname: McCarthy
authors.affiliation: John F. McCarthy and Claire M. Hannemann are with the Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Washington DC. Robert M. Bossarte is with the Epidemiology Program, Office of Public Health; Ira R. Katz is with the Office of Mental Health Operations; Caitlin Thompson is with the Suicide Prevention Program, Mental Health Services; and Christopher Nielson is with Predictive Analytics, Office of Business Intelligence and Analytics, Department of Veterans Affairs. Janet Kemp is with the VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY. Michael Schoenbaum is with the Office of Science Policy, Planning, and Communications, National Institute of Mental Health, Rockville, MD.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Bossarte
authors.affiliation: John F. McCarthy and Claire M. Hannemann are with the Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Washington DC. Robert M. Bossarte is with the Epidemiology Program, Office of Public Health; Ira R. Katz is with the Office of Mental Health Operations; Caitlin Thompson is with the Suicide Prevention Program, Mental Health Services; and Christopher Nielson is with Predictive Analytics, Office of Business Intelligence and Analytics, Department of Veterans Affairs. Janet Kemp is with the VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY. Michael Schoenbaum is with the Office of Science Policy, Planning, and Communications, National Institute of Mental Health, Rockville, MD.
authors.forename: Ira R
authors.initials: IR
authors.lastname: Katz
authors.affiliation: John F. McCarthy and Claire M. Hannemann are with the Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Washington DC. Robert M. Bossarte is with the Epidemiology Program, Office of Public Health; Ira R. Katz is with the Office of Mental Health Operations; Caitlin Thompson is with the Suicide Prevention Program, Mental Health Services; and Christopher Nielson is with Predictive Analytics, Office of Business Intelligence and Analytics, Department of Veterans Affairs. Janet Kemp is with the VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY. Michael Schoenbaum is with the Office of Science Policy, Planning, and Communications, National Institute of Mental Health, Rockville, MD.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Thompson
authors.affiliation: John F. McCarthy and Claire M. Hannemann are with the Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Washington DC. Robert M. Bossarte is with the Epidemiology Program, Office of Public Health; Ira R. Katz is with the Office of Mental Health Operations; Caitlin Thompson is with the Suicide Prevention Program, Mental Health Services; and Christopher Nielson is with Predictive Analytics, Office of Business Intelligence and Analytics, Department of Veterans Affairs. Janet Kemp is with the VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY. Michael Schoenbaum is with the Office of Science Policy, Planning, and Communications, National Institute of Mental Health, Rockville, MD.
authors.forename: Janet
authors.initials: J
authors.lastname: Kemp
authors.affiliation: John F. McCarthy and Claire M. Hannemann are with the Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Washington DC. Robert M. Bossarte is with the Epidemiology Program, Office of Public Health; Ira R. Katz is with the Office of Mental Health Operations; Caitlin Thompson is with the Suicide Prevention Program, Mental Health Services; and Christopher Nielson is with Predictive Analytics, Office of Business Intelligence and Analytics, Department of Veterans Affairs. Janet Kemp is with the VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY. Michael Schoenbaum is with the Office of Science Policy, Planning, and Communications, National Institute of Mental Health, Rockville, MD.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Hannemann
authors.affiliation: John F. McCarthy and Claire M. Hannemann are with the Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Washington DC. Robert M. Bossarte is with the Epidemiology Program, Office of Public Health; Ira R. Katz is with the Office of Mental Health Operations; Caitlin Thompson is with the Suicide Prevention Program, Mental Health Services; and Christopher Nielson is with Predictive Analytics, Office of Business Intelligence and Analytics, Department of Veterans Affairs. Janet Kemp is with the VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY. Michael Schoenbaum is with the Office of Science Policy, Planning, and Communications, National Institute of Mental Health, Rockville, MD.
authors.forename: Christopher
authors.initials: C
authors.lastname: Nielson
authors.affiliation: John F. McCarthy and Claire M. Hannemann are with the Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health Operations, Department of Veterans Affairs, Washington DC. Robert M. Bossarte is with the Epidemiology Program, Office of Public Health; Ira R. Katz is with the Office of Mental Health Operations; Caitlin Thompson is with the Suicide Prevention Program, Mental Health Services; and Christopher Nielson is with Predictive Analytics, Office of Business Intelligence and Analytics, Department of Veterans Affairs. Janet Kemp is with the VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY. Michael Schoenbaum is with the Office of Science Policy, Planning, and Communications, National Institute of Mental Health, Rockville, MD.
authors.forename: Michael
authors.initials: M
authors.lastname: Schoenbaum
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D018570:Risk Assessment; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data*; D000092864:Suicide Prevention