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VA, DOD update guidelines for patients at risk for suicide
The U.S. Department of Veteran Affairs and the U.S. Department of Defense updated their clinical practice guidelines for screening, evaluation, treatment and management of patients at risk for suicide.
A synopsis of the guidelines was published in the Annals of Internal Medicine.
“Suicide is a public health problem, with worsening trends in recent decades,” James Sall, PhD, FNP-BC, from the Veterans Health Administration and Texas A&M University, and colleagues wrote. “Nationwide, suicide rates increased 25% from 1999 to 2016. During that same time, the U.S. Department of Defense (DoD) active component suicide rate increased from 10.7 to 21.5 suicide-related deaths per 100,000 service members.”
To develop the guidelines, Kristen E. D’Anci, PhD, from the Center for Clinical Guidelines at the ECRI Institute, and colleagues conducted a systematic review of the literature. They used data from eight other systematic reviews and 15 randomized controlled trials published between November 2011 and May 2018 that evaluated therapies for patients at risk for suicide.
The updated VA/DoD guidelines recommend that all patients be screened and evaluated for suicide risk. The guidelines also recommend that physicians use several methods to assess suicide risk, because just one tool may not accurately measure an individual’s risk.
Pharmacologic therapies recommended in the guidelines include ketamine infusions for patients with major depression, which provided rapid improvement in suicidal ideation symptoms after just one dose. Lithium was recommended to reduce risk for suicide among those with unipolar depression or bipolar disorders.
In addition, the updated guidelines included nonpharmacologic approaches for patients with suicidal ideation, including cognitive behavioral therapy. Dialectical behavior therapy, which combines cognitive behavioral therapy with skill training and mindfulness techniques, was also recommended to treat suicidal ideation.
Restricting access to firearms, poisons and medications associated with overdose were also listed in the guidelines as methods to reduce suicide.
In an editorial accompanying the systematic review, Michael Hogan, PhD, of the Case Western Reserve School of Medicine, noted that although the update strengthens the VA/DoD guidelines, it will probably not significantly reduce suicide among veterans.
Hogan explained that because two-thirds of veterans who die by suicide each year are not eligible for or do not use VA health care, action to improve suicide care is needed outside the VA health care system.
“The most effective way to reduce veteran suicide is through actions that decrease suicide in the entire U.S. population,” he wrote. – by Erin Michael
References:
D’Anci KE, et al. Ann Intern Med. 2019;doi:10.7326/M19-0869.
Hogan M, et al. Ann Intern Med. 2019;doi:10.7326/M19-1796.
Sall J, et al. Ann Intern Med. 2019;doi:10.7326/M19-0687.
Disclosures: D’Anci reports receiving grants from the U.S. Department of Veterans Affairs during the conduct of the study. Hogan and Sall report no relevant financial disclosures. Please see synopsis and systematic review for all other authors’ relevant financial disclosures.