Linking Data to Understand Veteran Suicide
and Direct Effective Prevention Programs
Claire Hoffmire, PhD
Department of Veterans Affairs
VISN2 Center of Excellence for Suicide Prevention
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.
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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.”
VETERANS HEALTH ADMINISTRATION
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. Veterans
Percentage of all Suicides Identified as Veterans
VETERANS HEALTH ADMINISTRATION
6
Estimated Number of Veterans Who Die From Suicide Each Day
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7
The State Mortality Data Project
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“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
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–
–
–
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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
VETERANS HEALTH ADMINISTRATION
Project Status: May 2013
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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
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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
VETERANS HEALTH ADMINISTRATION
Project Status
*
**
*
*
Status
Have
Pending
Requested
Denied
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
VETERANS HEALTH ADMINISTRATION
Comparing SDR to National Suicide Surveillance Efforts
Nationally
Representative
Veteran
Identification
Health
Information
Circumstantial
Information
Time Lag
State Mortality
Project
NDI
X
X
X
(validated)
X
(misclassification exists)
NVDRS
X
(misclassification exists)
X
(VHA Veterans)
X
(Family/friend reported)
X
(limited)
X
(Family/friend reported)
Determined by
states
VETERANS HEALTH ADMINISTRATION
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%
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The Veteran population is changing
VETERANS HEALTH ADMINISTRATION
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
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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
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Partnering with the VA can greatly improve the accuracy of Veteran
status reporting on death certificates
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Coverage far exceeds that of NVDRS and can inform its expansion
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VA and DoD can add critical information to inform prevention
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VA Secretary Shinseki has requested the help of State Health
Departments to improve our understanding of Veteran suicide and
save lives
VETERANS HEALTH ADMINISTRATION
The Ultimate Goal: Identify all Veteran Suicides
We’re working
together to
close this gap!
VA-DOD NDI search
VHA
Veterans
All Veteran Suicides
VETERANS HEALTH ADMINISTRATION
State suicide
death
certificates
Acknowledgements
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Jan Kemp, RN, PhD – VA National Mental Health Program Director
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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
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Participating State Health Department POCs
VETERANS HEALTH ADMINISTRATION