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Abstract

Objective:

Encouraging patients at risk for suicide to reduce access to potentially lethal medications and drugs is a key component of evidence-based suicide prevention. However, little research has been done to inform interventions for reducing intentional self-harm.

Methods:

Semistructured interviews were conducted with 28 U.S. veterans who sought emergency care from the Veterans Health Administration between 2021 and 2023 to explore veterans’ perspectives on medication-related interventions, including opinions on intervention components (e.g., medication return envelopes). Matrix analysis was used to aggregate data into categories, which were predefined by using constructs from the health belief model (e.g., perceived benefits).

Results:

The participating veterans generally endorsed interventions as acceptable and were particularly supportive of distributing medication return envelopes. However, they often conceptualized these efforts as steps to prevent unintentional overdose or theft—not necessarily to prevent suicide—and rarely indicated that such interventions were appropriate for themselves. Across the interviews, participants identified important facilitators to care, such as ensuring that interventions were convenient and accounted for the perceived cost of disposing medications. Perspectives on engaging family or friends in interventions were mixed. The importance of the interventions was more readily acknowledged among participants with previous opioid use exposure—perspectives that appeared to stem from lived experiences.

Conclusions:

This study contributes important foundational knowledge that can be used to inform research and clinical initiatives aimed at preventing medication- and drug-related suicides.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 275 - 282
PubMed: 37933134

History

Received: 10 April 2023
Revision received: 7 August 2023
Accepted: 18 September 2023
Published online: 7 November 2023
Published in print: March 01, 2024

Keywords

  1. Suicide
  2. Self-destructive behavior
  3. Overdoses
  4. Veterans issues
  5. Emergency psychiatry
  6. Opioids

Authors

Details

Joseph A. Simonetti, M.D., M.P.H. [email protected]
U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre).
Ryan Holliday, Ph.D.
U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre).
Joseph Mignogna, Ph.D.
U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre).
Suzanne Thomas, M.A.
U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre).
Alexandra Smith, M.S.
U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre).
Marian Betz, M.D., M.P.H.
U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre).
Lisa A. Brenner, Ph.D.
U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre).
George Sayre, Psy.D.
U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre).

Notes

Send correspondence to Dr. Simonetti ([email protected]).

Competing Interests

Dr. Brenner reports receiving editorial remuneration from RAND and Wolters Kluwer and royalties from the American Psychological Association and Oxford University Press and serving as a consultant for sports leagues. The other authors report no financial relationships with commercial interests.

Funding Information

This work was supported by career development award 1IK2HX002861-01A2 from the VA Health Services Research and Development Service and the VA Rocky Mountain MIRECC for Suicide Prevention.The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the VA or the U.S. government.

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