Social and Clinical Variables Associated with Outpatient Mental Health Care Utilization following Positive Suicide Risk Screening.

Abstract

Veterans who do not utilize Veterans Health Administration care are considered a high public health priority because they are disproportionately represented among veteran suicide deaths. This study focused on identifying clinical and social characteristics associated with Veterans Health Administration outpatient mental healthcare utilization among veterans after a positive suicide risk screening (e.g., reporting suicidal intent or plan within past 30 days). This study conducted a retrospective, observational cohort study evaluating clinical and social predictors of Veterans Health Administration outpatient mental healthcare utilization 6 and 12 months after suicide risk screening within a primary care or mental health setting. Data were extracted from Veterans Health Administration's Corporate Data Warehouse, a compilation of data from electronic health records and other healthcare data sources. The sample included all veterans with a positive suicide risk screening in Veterans Health Administration Fiscal Year 2020 (October 1, 2019-September 30, 2020). Data were analyzed utilizing mixed-effects, multivariable logistic regression models controlling for age, gender, race, and Latine ethnicity. The study team conducted chart reviews in a random subsample of the analytic sample to identify potential care processes contributing to mental healthcare utilization. Across settings, veterans who did not utilize Veterans Health Administration outpatient mental health care after a positive suicide risk screening had fewer mental/medical comorbidities, fewer social determinants of health challenges (e.g., unemployment), and less past Veterans Health Administration mental healthcare utilization. Chart reviews showed absence of documented mental healthcare referrals as a common barrier to postscreening mental health outpatient care utilization. Veterans and providers may benefit from education and strategies for addressing barriers to mental healthcare utilization after a positive suicide risk screening with a particular focus on understanding referral processes. Future research should further explore modifiable processes to increase Veterans Health Administration mental health outpatient care utilization after a positive suicide risk screening.