title: Treatment of veterans with mental health symptoms in VA primary care prior to suicide.
abstract: OBJECTIVE
  We describe Veterans Affairs (VA) primary care received by veterans with mental health symptoms in the year prior to suicide to identify opportunities to improve care.
  
  
  METHODS
  Death certificate data from 11 states were linked to VA national patient care data for veterans who died by suicide in 2009 and had received VA care. We identified 118 age-, sex- and clinician-matched case-control pairs (suicide decedents and living controls) with mental health symptoms. Using McNemar's chi-square and paired t tests, we compare primary care follow-up received during the year prior to death.
  
  
  RESULTS
  Cases and controls received similar primary care clinician follow-up and treatment for mental health symptoms. Cases were less likely than controls to fill 90 or more total days of an antidepressant during the year (P=.02), despite no differences in prescription orders from clinicians (P=.05). Cases and controls were equally likely to fill 90 or more consecutive days of an antidepressant (P=.47). Across both groups, 48% (n=113) received assessment for suicidal ideation in primary care.
  
  
  CONCLUSIONS
  We identified two areas to improve primary care for veterans at risk for suicide: monitoring antidepressant treatment adherence and improving suicidal ideation assessment and follow-up for veterans with mental health symptoms.
authors.affiliation: Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, P.O. Box 1034 (R&D66), Portland, OR 97207, USA; Department of Psychiatry, Oregon Health & Science University, 3181 Sam Jackson Park Rd, Portland, OR 97239, USA. Electronic address: lauren.denneson@va.gov.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Denneson
authors.affiliation: Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, P.O. Box 1034 (R&D66), Portland, OR 97207, USA. Electronic address: Holly.Williams1@va.gov.
authors.forename: Holly B
authors.initials: HB
authors.lastname: Williams
authors.affiliation: Department of Social Welfare, UCLA Luskin School of Public Affairs, 3250 Public Affairs Building, Box 951656, Los Angeles CA 90095, USA. Electronic address: kaplanm@luskin.ucla.edu.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Kaplan
authors.affiliation: Department of Psychiatry, Oregon Health & Science University, 3181 Sam Jackson Park Rd, Portland, OR 97239, USA. Electronic address: mcfarlab@ohsu.edu.
authors.forename: Bentson H
authors.initials: BH
authors.lastname: McFarland
authors.affiliation: Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, P.O. Box 1034 (R&D66), Portland, OR 97207, USA; Department of Psychiatry, Oregon Health & Science University, 3181 Sam Jackson Park Rd, Portland, OR 97239, USA. Electronic address: Steven.Dobscha@va.gov.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000628:therapy; D016022:Case-Control Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D016247:Information Storage and Retrieval; D008297:Male; D008403:Mass Screening; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012559:Schizophrenia / Q000175:diagnosis / Q000628:therapy; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000628:therapy; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000628:therapy; D059020:Suicidal Ideation; D013405:Suicide; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*
chemical_list: D000928:Antidepressive Agents
keywords: Mental health; Primary care; Suicide; Veterans