Linking Data to Understand Veteran Suicide and Direct

Linking Data to Understand Veteran Suicide and Direct Effective Prevention Programs Claire Hoffmire, Ph. D Department of Veterans Affairs VISN 2 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. • 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 VETERANS HEALTH ADMINISTRATION 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 VETERANS HEALTH ADMINISTRATION

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 VETERANS HEALTH ADMINISTRATION

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-Do. D NDI search – VA-Do. D collaborative Data Repository • VA-Do. D NDI search, limited Do. D service record, Do. DSER VETERANS HEALTH ADMINISTRATION

Comparing SDR to National Suicide Surveillance Efforts State Mortality Project Nationally Representative Veteran Identification Health Information Circumstantial Information Time Lag 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% VETERANS HEALTH ADMINISTRATION

14 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 • 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 Do. D 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 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 • Jan Kemp, RN, Ph. D – VA National Mental Health Program Director • • • Robert Bossarte, Ph. D – Acting Associate Director, COE Kenneth Conner, Psy. D, MPH – Director, COE Rebecca Piegari, MS – Statistician, COE Brady Stephens, MS – Statistician, COE Heather Shaw, BS – Research Assistant, COE Janet Mc. Carten, Ph. D – Health Science Specialist, COE • Participating State Health Department POCs VETERANS HEALTH ADMINISTRATION