{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T22:31:57Z","timestamp":1773095517699,"version":"3.50.1"},"reference-count":50,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T00:00:00Z","timestamp":1677456000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Many Veterans at high risk for suicide are identified in Veterans Health Administration (VHA) emergency departments (ED). Little is known about what may predict care utilization in this population. To address this knowledge gap, we explored factors associated with Veterans' lack of VHA care utilization following a positive suicide risk screen in the ED.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a retrospective observational study, we identified all patients who were seen in a VHA ED from October 1, 2019, to September 30, 2020. We examined factors associated with not utilizing VHA mental health (MH) and all VHA care in the 6\u2009months following a positive suicide ED screen. Predictors included comorbidity, homelessness, and MH visit and diagnosis history.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 23,446 Veterans with a positive suicide risk screen in the ED in fiscal year 2020. Overall, 4.1% had no VHA MH visits 6\u2009months postscreen. The probability of not utilizing MH care was significantly higher for Veterans with no comorbidity (4.7% vs. 3.4% for mild comorbidity), no MH diagnosis (10.5% vs 2.8%), no past\u2010year MH visits (13.6% vs 2.3%), and no past\u2010year homelessness (5.4% vs. 1.1%). A smaller proportion of the population did not receive any VHA care 6\u2009months postscreen (0.5%). Veterans who did not experience homelessness (0.6% vs 0.2%), had no MH diagnosis (1.6% vs. 0.3%), and had no previous MH visits (1.9% vs 0.2%) were significantly more likely to not utilize VHA care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Veterans who do not utilize VHA care after a positive suicide risk screen appear to have fewer documented health and housing concerns than those who do receive care. Yet, Veterans with a positive suicide risk screen who are otherwise healthy may remain at elevated risk for suicide following their ED visit. ED providers may consider enhanced follow\u2010up care to mitigate suicide risk for these Veterans.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14695","type":"journal-article","created":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T14:58:55Z","timestamp":1676386735000},"page":"321-330","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Factors associated with a lack of health care utilization among Veterans after a positive suicide screen in the emergency department"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3868-1529","authenticated-orcid":false,"given":"Avery Z.","family":"Laliberte","sequence":"first","affiliation":[{"name":"Center to Improve Veteran Involvement in Care, VA Portland Health Care System U.S. Department of Veterans Affairs (VA)  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Apoorva","family":"Salvi","sequence":"additional","affiliation":[{"name":"Center to Improve Veteran Involvement in Care, VA Portland Health Care System U.S. Department of Veterans Affairs (VA)  Portland Oregon USA"},{"name":"Center for Policy and Research in Emergency Medicine Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Hooker","sequence":"additional","affiliation":[{"name":"Center to Improve Veteran Involvement in Care, VA Portland Health Care System U.S. Department of Veterans Affairs (VA)  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brandon","family":"Roth","sequence":"additional","affiliation":[{"name":"Center to Improve Veteran Involvement in Care, VA Portland Health Care System U.S. Department of Veterans Affairs (VA)  Portland Oregon USA"},{"name":"Portland VA Research Foundation  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Handley","sequence":"additional","affiliation":[{"name":"Center to Improve Veteran Involvement in Care, VA Portland Health Care System U.S. Department of Veterans Affairs (VA)  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9261-7742","authenticated-orcid":false,"given":"Kathleen","family":"Carlson","sequence":"additional","affiliation":[{"name":"Center to Improve Veteran Involvement in Care, VA Portland Health Care System U.S. Department of Veterans Affairs (VA)  Portland Oregon USA"},{"name":"Oregon Health &amp; Science University\u2013Portland State University School of Public Health Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denise","family":"Hynes","sequence":"additional","affiliation":[{"name":"Center to Improve Veteran Involvement in Care, VA Portland Health Care System U.S. Department of Veterans Affairs (VA)  Portland Oregon USA"},{"name":"Health Management and Policy, School of Social and Behavioral Sciences, College of Public Health and Human Sciences Oregon State University  Corvallis Oregon USA"},{"name":"School of Nursing Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana\u00efs","family":"Tuepker","sequence":"additional","affiliation":[{"name":"Center to Improve Veteran Involvement in Care, VA Portland Health Care System U.S. Department of Veterans Affairs (VA)  Portland Oregon USA"},{"name":"Division of General Internal Medicine and Geriatrics Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6490-164X","authenticated-orcid":false,"given":"Jason I.","family":"Chen","sequence":"additional","affiliation":[{"name":"Center to Improve Veteran Involvement in Care, VA Portland Health Care System U.S. Department of Veterans Affairs (VA)  Portland Oregon USA"},{"name":"Department of Psychiatry Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,2,27]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"National Veteran Suicide Prevention Annual Report","author":"VHA Office of Mental Health and Suicide Prevention","year":"2022"},{"key":"e_1_2_10_3_1","volume-title":"Fiscal Years 2022\u201328 Strategic Plan","author":"Department of Veterans Affairs","year":"2022"},{"key":"e_1_2_10_4_1","volume-title":"National Hospital Ambulatory Medical Care Survey: 2019 Emergency Department Summary Tables","author":"Cairns C","year":"2019"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-014-2767-3"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2015.09.029"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2010.06.562"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/sltb.12226"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-020-01019-6"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2011.10111704"},{"key":"e_1_2_10_11_1","volume-title":"VA\/DoD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide","author":"The Assessment and Management of Suicide Risk Work Group","year":"2019"},{"key":"e_1_2_10_12_1","volume-title":"Patients at Risk for Suicide \u2010 Pocket Guide","author":"The Assessment and Management of Suicide Risk Work Group","year":"2019"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0265474"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_2_10_15_1","unstructured":"About VA disability ratings. 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