title: How Veterans Health Administration Suicide Prevention Coordinators Assess Suicide Risk.
abstract: This cross-sectional study was designed to examine the suicide risk assessment practices of Suicide Prevention Coordinators (SPCs) within the Veterans Health Administration. Specifically, this study sought to (1) identify factors SPCs consider most important in assessing risk and patient priority; (2) measure the level of consistency and agreement between SPCs in assessing suicide risk and prioritizing cases; and (3) measure individual SPC consistency between cases. SPCs (n = 63) responded to online survey questions about imminent and prolonged risk for suicide in response to 30 fictional vignettes. Combinations of 12 acute and chronic suicide risk factors were systematically distributed throughout the 30 vignettes using the Fedorov () procedure. The SPCs were also asked to identify the level of priority for further assessment both disregarding and assuming current caseloads. Data were analysed using clinical judgement analysis. Suicidal plan, β = 1.64; 95% CI (1.45, 1.82), and preparatory behaviour, β = 1.40; 95% CI (1.23, 1.57), were considered the most important acute or imminent risk factors by the SPCs. There was less variability across clinicians in the assessment of risk when alcohol use (p = 0.02) and hopelessness (p = 0.03) were present. When considering acute or imminent risk factors, there was considerable variability between clinicians on a vignette-by-vignette basis, median SD = 0.86 (range = 0.47, 1.13), and within individual clinicians across vignettes, median R2= 0.80 (0.49, 0.95). These findings provide insight into how this group of providers think about acute and chronic risk factors contributing to imminent suicide risk in Veterans. Copyright © 2016 John Wiley & Sons, Ltd.
  
  
  CONCLUSIONS
  Identifies factors that practitioners consider most important in suicide risk assessment Discusses how to distinguish between chronic and acute risk for suicide Identifies factors that lead to more consistent clinical judgments.
authors.affiliation: Rocky Mountain Mental Illness Research, Education and Clinical Center and University of Colorado Anschutz Medical Campus, Denver, Colorado, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Pease
authors.affiliation: Rocky Mountain Mental Illness Research, Education and Clinical Center and Colorado School of Public Health, Denver, Colorado, USA.
authors.forename: Jeri E
authors.initials: JE
authors.lastname: Forster
authors.affiliation: Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver, Colorado, USA.
authors.forename: Collin L
authors.initials: CL
authors.lastname: Davidson
authors.affiliation: Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver, Colorado, USA.
authors.forename: Brooke Dorsey
authors.initials: BD
authors.lastname: Holliman
authors.affiliation: Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver, Colorado, USA.
authors.forename: Emma
authors.initials: E
authors.lastname: Genco
authors.affiliation: Rocky Mountain Mental Illness Research, Education and Clinical Center and University of Colorado Anschutz Medical Campus, Denver, Colorado, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Brenner
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health; D000092864:Suicide Prevention
keywords: Self-directed Violence; Suicide; Suicide Risk Assessment; Veterans