Symposia
Telehealth/m-Health
Carol Chu, Ph.D. (she/her/hers)
Minneapolis VAMC
Minneapolis, Minnesota
Casey Gilmore, PhD (he/him/his)
Research Investigator
Minneapolis VA Health Care System
Minneapolis, Minnesota
Background: Suicide rates are especially high in the first month after Veterans discharge from inpatient psychiatric treatment. Unfortunately, the factors contributing to suicide risk post-discharge are not well understood as research examining this high-risk period has largely relied on retrospective, infrequent sampling methods. This is a significant limitation as recent research shows that suicide risk fluctuates within individuals over short time periods. Thus, ecological momentary assessment (EMA) methods, which capture real-time information through multiple brief daily surveys, are needed to understand the potentially rapid progression of suicide risk post-discharge. No studies have used EMA methods to examine Veterans suicide risk post-discharge. The purpose of this study was to examine the degree of fluctuation in suicide risk and related factors among Veterans after discharge from inpatient treatment.
Method: Veterans admitted to a VA inpatient psychiatric unit with elevated suicide risk completed baseline measures pre-discharge and 30 days of EMA surveys (3x per day) post-discharge. Baseline and EMA surveys assessed suicidal thinking and intent as well as related risk factors, including mood, help-seeking, stress, social connection, sleep, impulsivity, hopelessness, alcohol craving, and suicide capability. Short-term variability in these constructs was examined using intraclass correlations (ICC; 1 – ICC is the proportion of variance attributed to within-person variability) and root mean square of successive differences (average variability in a measure over time).
Results: Findings based on the Veterans that have been sampled thus far suggest that intensity of suicidal thinking and intent varied within a day and over the course of most days; there was greater variability in the first two weeks post-discharge. There was also considerable variability in severity of suicide risk factors over the course of most days.
Conclusion: This study provided a fine-grained examination of suicide risk and related factors and shows that suicide risk and related factors change over short time periods. EMA is a promising approach to improving the short-term prediction of suicide risk in the high-acuity period after Veterans discharge from inpatient treatment.