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Amy Kilbourne, PhD, MPH, Director of QUERI

Director's Letter

Preventing Suicide among Veterans: Data to Achieve Real World Impact

September is national suicide prevention month, but nationally, suicide impacts Veterans and their families every day. There are about five suicide-related deaths each day among Veterans receiving care in the VA healthcare system (Facts about Veteran Suicide). Between 2005 and 2017, 78,875 Veterans committed suicide—more than the number of Americans killed in each major conflict except for World War II and the Civil War. There is also growing concern that social isolation from the COVID-19 lockdowns may contribute to increased suicide risk.

One of the most vexing challenges in supporting efforts to prevent suicide among Veterans is our limited ability to obtain a comprehensive picture of the data on suicide among Veterans in the U.S. Our access to key data on health factors related to suicide risk is limited to those receiving VA care, and the cause-specific data VA relies on to track suicide rates from the CDC’s National Death Index can have a two-year lag time. These data barriers limit our ability to conduct population-level research and to evaluate programs and policies to prevent suicide among Veterans.

VA is tackling the data issue head on, notably by facilitating access to comprehensive data on suicide-related mortality; for example, through the VA/DoD Mortality Data Repository (MDR), which has integrated information from the National Death Index (NDI) and data from VA and DoD administrative records. VA also held its first Data Summit for Suicide Prevention, described below, that featured HSR&D and QUERI investigators. This effort was, in part, driven by major policy initiatives including the Foundations for Evidence-based Policymaking Act of 2018 (PL 115-435) to ensure open data and the requirement that budgets be informed by evidence and evaluation, and President Trump’s Executive Order 13861: President's Roadmap to Empower Veterans and End a National Tragedy of Suicide (PREVENTS). Notably, the PREVENTS Executive Order includes prioritizing suicide surveillance and research that take into account multilevel factors to tailor and deliver effective suicide prevention programs, and promoting “foundational changes to the way research is conducted — including improving the speed and accuracy with which research is translated into practice, improving efficiency through data sharing and data curation practices, and using innovative funding techniques to drive team science and reproducibility.”

But data must be followed by rigorous evaluation in order to speed the translation of research into practice. To this end, we feature QUERI investigators who are leading efforts to more rapidly translate research on suicide prevention into practice, notably the national evaluations on the Caring Letters initiative, the VA Risk ID initiative, the largest implementation of population-based suicide risk screening and evaluation in any United States healthcare system to date, and the VISN-partnered implementation initiative involving Caring Letters. Ultimately, these initiatives can inform national policies and strategies to combat suicide among Veterans and serve as an example of a comprehensive national strategy informing programs and policies.

Amy Kilbourne, PhD, MPH
Director, Quality Enhancement Research Initiative