Citation

Hogan M. Ann. Intern Med. 2019; ePub(ePub): ePub.

Affiliation

Case Western Reserve School of Medicine, Cleveland, Ohio (M.H.).

Copyright

(Copyright © 2019, American College of Physicians)

DOI

10.7326/M19-1796

PMID

31450241

Abstract

Suicide is the 10th leading cause of death in the United States, and its rates are increasing. It has become a crushing problem among veterans, with 20 deaths a day. Sall and colleagues (1) have presented a synopsis of the 2019 U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) joint clinical practice guideline on the assessment and management of patients at risk for suicide. This guideline updates the VA's 2013 recommendations (2), strengthening what was already the strongest clinical guidance regarding suicide, and has the potential to improve the quality of care for at-risk patients. However, these recommendations are unlikely to dramatically reduce the burden of veteran suicide.

Why is this the case? What else must be done to address this intolerable loss of life among those who have served their country? The great majority of veterans are not eligible for VA health care or do not use it; therefore, more than two thirds of the veterans who die by suicide were not receiving care within the VA system. Thus, reducing veteran suicide depends largely on actions to improve suicide care outside the VA. The suicide rate has decreased among veterans who use VA services (3), possibly because of the 2013 guideline and the addition of suicide prevention specialists at all VA medical centers. Substantial improvements also have been made to the Veterans Crisis Line, a 24/7 crisis counseling service operated by the VA that often is reached through the National...

Language: en