title: Suicide Risk Management Protocol in Post-Cardiac Arrest Survivors: Development, Feasibility, and Outcomes.
abstract: BACKGROUND
  Suicidal ideation is an important part of the spectrum of depression, but studies of outcomes after cardiac events often avoid asking about suicide as part of their assessment due to perceived resource constraints and the complexity of managing this finding.
  
  
  OBJECTIVE
  To describe the development, feasibility, and outcomes of a suicide risk management protocol implemented by research assistants administering the Patient Health Questionnaire Depression Scale (PHQ-9).
  
  
  METHODS
  Patients surviving in-hospital cardiac arrest at any Veterans Affairs hospital during 2014 to 2015 received PHQ-9 screening as a part of longitudinal telephone or mail interviews administered at 3, 6, 9, and 12 months after hospital discharge. Those who screened positive for suicidal ideation were administered a telephone risk assessment protocol.
  
  
  RESULTS
  Fifty-five of 366 (15%) interviewed Veterans endorsed suicidal ideation according to the PHQ-9 on 82 of their completed interviews. Of those who endorsed suicidal ideation during their interview, 81% of interviews included passive suicidal ideation without intent or plan. Five (9%) patients were recommended to receive expedited follow-up with a mental health provider or suicide prevention coordinator located within their Veterans Affairs healthcare facility. In 50 (63%) interviews, the patient already had reliable resources, such as a mental health provider or the number to the Veterans Crisis Line.
  
  
  CONCLUSIONS
  Suicidal ideation is common after in-hospital cardiac arrest, although most patients are at low risk. Addressing suicidal ideation in an observational research study is feasible, with a detailed protocol and research staff who can respond to incidents of high-risk suicidal ideation in collaboration with study clinicians.
authors.affiliation: 1 Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Bucy
authors.affiliation: 1 Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Kaitlyn A
authors.initials: KA
authors.lastname: Hanisko
authors.affiliation: 1 Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Kamphuis
authors.affiliation: 1 Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.|2 Department of Internal Medicine.
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.affiliation: 1 Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.|2 Department of Internal Medicine.|3 Institute for Social Research, and.
authors.forename: Theodore J
authors.identifier: http://orcid.org/0000-0002-4226-9310
authors.initials: TJ
authors.lastname: Iwashyna
authors.affiliation: 1 Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.|4 Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Pfeiffer
mesh_terms: D000368:Aged; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006323:Heart Arrest / Q000523:psychology* / Q000628:therapy; D006787:Hospitals, Veterans; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D011569:Psychiatric Status Rating Scales; D018570:Risk Assessment / Q000379:methods; D012308:Risk Management / Q000379:methods*; D059020:Suicidal Ideation; D017741:Survivors / Q000523:psychology*; D013689:Telephone; D014481:United States; D014728:Veterans / Q000523:psychology
keywords: cardiac arrest; critical illness; depression; intensive care unit; suicide