Trust is the basis for effective suicide risk screening and assessment in veterans
Open accessAbstract
Background To reduce suicides among Veterans, the Department of Veterans Affairs (VA) has designated suicide risk assessments for Veterans who screen positive for depression or post-traumatic stress disorder as a national performance goal. Many VA Medical Centers (VAMCs) are using brief suicidal ideation screens, administered in non-mental health ambulatory care settings, as the first step in the assessment process.Objective To explore Veterans' perceptions of the suicide screening and risk assessment process, the barriers and facilitators to disclosing suicidal thoughts, and perceptions of possible consequences of revealing suicidal thoughts.Design Investigators recorded one semi-structured interview with each Veteran. Transcripts were analyzed using a modified grounded theory approach.Participants Thirty-four Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans who screened positive for suicidal ideation in non-mental health ambulatory care settings in 2009 and 2010.Key results Veterans accepted the need to assess suicide risk. They increasingly experienced attempts to suppress and avoid thoughts of suicide as burdensome and exhausting. Despite this, Veterans often failed to disclose severe and pervasive suicidal thoughts when screened because: (1) they considered suicidal thoughts as shameful and a sign of weakness; (2) they believed suicidal thoughts were private and not to be divulged to strangers; (3) they worried that disclosure would lead to unwanted hospitalization or medication recommendations; and (4) the templated computer reminder process was perceived as perfunctory and disrespectful. In contrast, admitting and discussing thoughts of suicide with a health provider who focused on building a relationship, demonstrated genuineness and empathy, offered information on the rationale for suicide risk assessment, and used straightforward and understandable language, all promoted trust that resulted in more honest disclosure of suicidal thoughts.Conclusion In ambulatory care settings, both provider behaviors and system modifications may lead to more honest disclosure of suicidal thoughts.
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Internalization of negative public perceptions, or self-stigma, could prevent accurate disclosure of STBs.
“The internalization of these negative public perceptions, or self-stigma, could also prevent accurate disclosure of STBs (Ganzini et al., 2013).”
From Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks (2023) · cites this paper as Ganzini et al., 2013
In “Barriers to Disclosure of Suicidal Ideation” (page unavailable), veterans describe hiding suicidal thoughts because seeking help felt like weakness; the paper also links reluctance to disclose to stigma and shame. This supports the claim for suicidal thoughts among veterans, but the cited passages do not establish the same point for disclosure of suicidal behaviors or populations beyond veterans. (LLM, conf=0.85)
Experimental — accuracy not yet measuredFear of involuntary hospitalization is among the most cited reasons for concealing or minimizing STBs.
“as a key example, fear of involuntary hospitalization is among the most cited reasons for concealing or minimizing STBs (Blanchard & Farber, 2020; Hom et al., 2017; Ganzini et al., 2013).”
From Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks (2023) · cites this paper as Ganzini et al., 2013
The Barriers to Disclosure of Suicidal Ideation section reports that veterans feared disclosure could lead to hospitalization, possibly involuntarily, and describes veterans concealing or minimizing suicidal thoughts. The paper does not establish that this fear is among the most frequently cited reasons, nor does its finding cover the full range of suicide-related thoughts and behaviors (STBs). (LLM, conf=0.86)
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- Authors
- Ganzini, L., Denneson, L. M., Press, N., Bair, M. J., Helmer, D. A., Poat, J., & Dobscha, S. K.
- Affiliations
- Portland VA Medical Center (US)
- Oregon Health & Science University (US)
- Richard L. Roudebush VA Medical Center (US)
- Veterans Health Administration (US)
- Corresponding author
- Ganzini, Linda
- Venue
- Journal of General Internal Medicine
- Published
- 2013-04-12
- Volume
- 28
- Issue
- 9
- Pages
- 1215-1221
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC3744302
- OpenAlex
- W2001706719
- Cited by
- 149
- References
- 15
- Citations by year
- 2026: 11 · 2025: 11 · 2024: 14 · 2023: 9 · 2022: 13 · 2021: 17 · 2020: 16 · 2019: 9 · 2018: 10 · 2017: 9 · 2016: 9 · 2015: 8 · 2014: 10 · 2013: 2
- FWCI
- 10.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Health Services Research and Development
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Social Psychology › Mental Health via Writing
- Keywords
- suicide risk assessment, suicide risk screening, veterans, suicidal ideation, trust in healthcare providers, barriers to disclosure, shame, provider-patient relationship, post-traumatic stress disorder, depression, OEF/OIF veterans
- MeSH terms
- Suicide Prevention, Adult, Attitude to Health, Depression, Female, Humans, Interview, Psychological, Male, Mass Screening, Patient Acceptance of Health Care, Professional-Patient Relations, Stress Disorders, Post-Traumatic, Suicide, Truth Disclosure, United States, Veterans, Risk Assessment, Trust, Suicidal Ideation
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