Treatment of veterans with mental health symptoms in VA primary care prior to suicide

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. Method: 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. Conclusion: 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.