Linking Data to Understand Veteran Suicide and Direct Effective Prevention Programs Claire Hoffmire,...

Linking Data to Understand Veteran Suicide and Direct Effective Prevention Programs

Claire Hoffmire, PhDDepartment of Veterans AffairsVISN2 Center of Excellence for Suicide Prevention

VETERANS HEALTH ADMINISTRATION

Suicide Mortality Surveillance: The Cornerstone of Suicide Prevention

• Effective surveillance systems:– Inform the development of targeted prevention strategies that have

the potential to meaningfully reduce suicide burden– Help to evaluate the impact of existing and newly implemented

prevention programs.

• National suicide surveillance systems:– National Violent Death Reporting System (NVDRS)– NDI– VA State Mortality Project

• National priority to improve suicide surveillance– 2012 National Strategy for Suicide Prevention goal

• “Increase the timeliness and usefulness of national surveillance systems relevant to suicide prevention and improve the ability to collect, analyze, and use this information for action.”

National Average: 11.44/100,000

Data obtained from WISQARS Fatal Injury Reports: http://www.cdc.gov/injury/wisqars

NVDRS Coverage


Suicide among U.S. VeteransPercentage of all Suicides Identified as Veterans

6


Estimated Number of Veterans Who Die From Suicide Each Day

7


The State Mortality Data Project

• “The Department of Veterans Affairs believes that a comprehensive suicide prevention program requires timely and accurate information beyond that acquired from it’s internal patient population.” – 2012 Suicide Data Report

– Overcome delay’s associated with national mortality data– Accurately identify true Veterans– Understand suicide among all Veterans– Evaluate differences and changes in outcomes among VHA utilizing

Veterans

• A State-VA Collaborative Project– In 2010 VA Secretary Shinseki requested collaboration and support from all

U.S states– Data on all known suicides reported from 1999 through 2015 – Will be used, in part, to fulfill Public Law 111.163 to determine the number

of Veterans who died from suicide 1999-2009


Project Status: May 2013

• Data Requested from death certificates– SSN, Name, DOB, DOD, Age, Sex, Race/ethnicity, Marital status,

Education, ICD-10 Cause of death, State & County of residence, County of death, Veteran Status, Industry, occupation

• Project Barriers– Inconsistent availability of requested information in all states– State barriers to providing non-resident data – State preference to provide de-indentified data due to conflicting

interpretation of Social security laws

Status Have Pending Requested Denied

Project Status

*

* *

*

*

In Negotiation


Linking to VA Data

• Validation of Veteran Status– Partnership with the DOD to accurately identify all Veterans– Preliminary evidence indicates that death certificate misclassification

exists– Improve comparison of Veterans to non-Veterans

• Identification of VHA service utilization– Directly compare VHA & non-VHA Veterans for the first time– Medical information also available for VHA users

• Inclusion of state data in suicide mortality repositories– VA Suicide Data Repository

• State records, annual VA NDI all-cause search, SPAN, VCL, expanded VA-DoD NDI search

– VA-DoD collaborative Data Repository • VA-DoD NDI search, limited DoD service record, DoDSER


Comparing SDR to National Suicide Surveillance Efforts

State Mortality Project

NDI NVDRS

Nationally Representative

X X

Veteran Identification

X (validated)

X (misclassification

exists)

X (misclassification

exists)

Health Information

X (VHA Veterans)

X(Family/friend

reported)

Circumstantial Information

X(limited)

X(Family/friend

reported)

Time Lag Determined by states

2-3 years 18-24 months


State Mortality Project Preliminary Findings: Death Certificate misclassification of Veteran status

1999-2008 overall Sensitivity Estimates

Males: 90%Females: 68%

18-39 years: 84%40-64 years: 92%


The Veteran population is changing

14


Joining Forces to Save Lives:Why initiate or continue State-VA Partnerships?

• The Veteran population is changing making accurate and timely surveillance of Veteran suicide mortality more critical than ever

• Veterans make up nearly 20% of all suicide decedents– Nearly 8,000 Veterans die by suicide every year– In the next 5 years, the NAASP set a goal to save 20,000 lives = 4,000 lives

annually

• Partnering with the VA can greatly improve the accuracy of Veteran status reporting on death certificates

• Coverage far exceeds that of NVDRS and can inform its expansion

• VA and DoD can add critical information to inform prevention

• VA Secretary Shinseki has requested the help of State Health Departments to improve our understanding of Veteran suicide and save lives


State suicide death certificates

VA-DOD NDI search

The Ultimate Goal: Identify all Veteran Suicides

All Veteran Suicides

VHA Veterans

We’re working together to close this gap!


Acknowledgements

• Jan Kemp, RN, PhD – VA National Mental Health Program Director

• Robert Bossarte, PhD – Acting Associate Director, COE• Kenneth Conner, PsyD, MPH – Director, COE• Rebecca Piegari, MS – Statistician, COE• Brady Stephens, MS – Statistician, COE• Heather Shaw, BS – Research Assistant, COE• Janet McCarten, PhD – Health Science Specialist, COE

• Participating State Health Department POCs

Linking Data to Understand Veteran Suicide and Direct Effective Prevention Programs Claire Hoffmire,...

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