ADVERTISEMENT
Patient-Centered, Whole Health Treatment Reduces Suicide Risk in Veterans
Using the whole health (WH) model of care currently implemented by the Veterans Health Administration (VHA) may help reduce suicide risk in veterans with psychiatric disorders, according to study findings published in Complementary Therapies in Medicine.
The WH model is a person-centered approach to care or, as defined on the US Department of Veteran Affairs (VA) website, a focus on “what matters to you, not what is the matter with you.”
“WH programming shows promise to reduce suicide risk and the need for mental health services among this population,” lead author William Marchand, VISN 19 Whole Health Flagship Site, University of Utah School of Medicine, and co-authors said. “Additionally, WH services were underutilized and there was a lack of treatment engagement.”
Related: Greater Suicide Prevention Efforts Needed in Clinical Practice, Experts Say
Researchers sought to investigate the possible success of the then-recently implemented WH program, which was rolled out at 36 VA facilities in 2018.
The retrospective study was conducted at a VHA medical center of 7138 veterans diagnosed with mental health disorders from March 2017 to February 2020. Primary outcome measures in the study were medication prescriptions, mental health treatment services use, pain scores, and suicide-related behaviors. Researchers examined the following WH interventions and treatments: mindfulness training, health education, well-being and nutrition classes, and health coaching.
Out of 7138 veterans, only 305 had at least 1 WH appointment. Although no differences were found between those who went to WH appointments and those who didn’t, researchers noted that older veterans who had served further in the past (such as in the Vietnam War and World War II) were less likely to use the resource. Of those who did utilize the WH resource, use of mental health services and suicide risk both significantly decreased. This group was also more likely to report self-harm and histories of suicidal thoughts. Suicide attempts significantly increased in patients who did not use the WH resources.
Researchers hypothesized that the low rate of usage of the WH resource was due to a lack of awareness of available services.
Although this study did not examine stigma, past studies have found a connection between mental health stigma and veterans, as well as current military personnel, which could have also contributed to the low participation rate.
Age is a significant contributor to whether a veteran will seek help, according to a 2020 study published in the Public Policy & Aging Report. Use of VHA mental health services by veterans under the age of 40 increased 94% from 2003–2011. Meanwhile, although older veterans have higher rates of PTSD, they are “less likely to seek specialty mental health services, due to stigma, less knowledge/access to resources, and a tendency to address mental health needs in primary care,” researchers said in the study.
In a 2015 review published in Epidemiologic Reviews, researchers found that 60% of military personnel who experience mental health problems do not seek help, with one of the most frequently reported barriers being concerns about stigma. The 2 most-endorsed concerns listed were "My unit leadership might treat me differently," with a weighted prevalence of 44.2%, and "I would be seen as weak," with a 42.9% weighted prevalence.
In another study published in 2010 in Military Psychology, half of the soldiers and Marines who met criteria for the study felt that seeking mental health treatment would result in being seen as “weak, being blamed for the problem, being treated differently by unit leaders, and having harm done to their careers.” In the same study, 55%-62% of soldiers and Marines with major depression, generalized anxiety disorder, or post-traumatic stress disorder (PTSD) said they were not interested in getting help.
The current Veterans Health Administration study “results suggest that WH programming was acceptable to the population, but utilization rates were low. Outreach efforts might enhance utilization,” researchers concluded. “Rigorous studies should be conducted to determine if these results can be replicated, as well as to investigate potential mechanisms of suicide risk reduction.”
References
