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ISDS 2012 Conference Abstracts

Characteristics of Veterans Accessing the Veterans
Affairs Telephone Triage Who Have Depression or
Suicidal Ideation: Opportunities for Intervention
Alison Ludwig*1, 2, Cynthia Lucero-Obusan1, Patricia Schirmer1 and Mark Holodniy1, 3

1VA Office of Public Health Surveillance and Research, Palo Alto, CA, USA; 2Epidemic Intelligence Service, Centers for Disease
Control and Prevention, Atlanta, GA, USA; 3Stanford University School of Medicine, Palo Alto, CA, USA

Objective
To characterize Veterans who call telephone triage because of sui-

cidal ideation (SI) or depression and to identify opportunities for sui-
cide prevention efforts among these telephone triage users using a
biosurveillance application.

Introduction
Veterans accessing Veterans Affairs (VA) health care have higher

suicide rates and more characteristics associated with suicide risk, in-
cluding being male, having multiple medical and psychiatric comor-
bidities, and being an older age, compared with the general U.S.
population. The Veterans Crisis Line is a telephone hotline available
to Veterans with urgent mental health concerns; however, not all Vet-
erans are aware of this resource. By contrast, telephone triage is a na-
tional telephone-based triage system used by the VA to assess and
triage all Veterans with acute medical or mental health complaints.

Methods
The VA Electronic Surveillance System for Early Notification of

Community-based Epidemics (ESSENCE) was queried for telephone
triage calls during January 1–June 30, 2012. Calls were classified as
SI or depression when the triage nurse selected SI or depression as the
Veteran’s chief complaint from a set of fixed options. Demographic
and recommended follow-up time and location information was re-
viewed. A random sample of 20 SI calls and 50 depression calls were
selected for chart review to determine whether Veterans were exam-
ined in a clinic or followed up by a clinician by telephone within 2
weeks of the veteran’s call.

Results
During January 1–June 30, 2012, 253,573 total calls were placed

to telephone triage. Among these calls, 2,460 unique Veterans placed
417 calls for SI and 2,290 calls for depression. This represents 1%
(2,707/253,573) of all calls placed during the period. All encounter in-
formation is available in the surveillance application within 24 hours
of the call being placed. Median age of callers was 55 years (range:
19–94); 86% were male; and 6% placed repeat calls. The median
number of repeat calls was 2 (range: 2–10). Among the 2,707 calls for

SI or depression, 1,286 (48%) were made after routine business hours
(5:00 p.m.–8:00 a.m.), and 646 (24%) were made on weekends. The
greatest proportion of calls were from Wisconsin and Northern Illi-
nois (17%) and the Southeastern United States (14%). Among the
2,290 calls for depression, 1,401 callers (61%) were recommended
for urgent follow up or within 24 hours. 771 (34%) were assigned a
follow up location of an emergency department; 117 (5%) an urgent
care; 1,332 (58%) a physician’s office or clinic; 52 (2%) self-care at
home; and 18 (1%) were unspecified. Among the 417 calls for SI,
callers 410 (98%) were recommended for urgent follow-up or within
24 hours. 330 (79%) were assigned a follow-up location of an emer-
gency department; 38 (9%) an urgent care; 43 (10%) a physician’s
office or clinic; 3 (1%) self-care at home; and 3 (1%) unspecified.
Among the 20 SI and 50 depression calls for which the charts were
reviewed, 1 (5%) SI call and 6 (12%) depression calls had no docu-
mented follow-up by telephone or in person with a clinician within 2
weeks of initial call.

Conclusions
Telephone triage represents an additional data source available to

surveillance applications. Although telephone triage is not the tradi-
tional method provided by the VA for triage of urgent mental health
concerns, >2,000 Veterans called it with acute symptoms of SI or de-
pression during January–June 2012. Training for suicide prevention
should be prioritized for operators working during the high-volume
periods of off-hours and weekends when approximately half and one-
quarter of calls were received, respectively. We recommend standard
notification of suicide prevention coordinators regarding calls to tele-
phone triage for SI or depression to prevent loss to follow-up among
Veterans at risk for suicide. Further investigation into reasons for in-
creased call burden in identified geographic areas also is recom-
mended.

Keywords
Surveillance; Veterans; Suicide Risk

*Alison Ludwig
E-mail: Alison.Ludwig@va.gov

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e136, 2013