Harmonizing federal interagency traumatic brain injury research data to examine depression and suicide-related outcomes.

OBJECTIVE: This proof-of-concept study was conducted to establish the feasibility of compiling Federal Interagency Traumatic Brain Injury Research (FITBIR) data pertaining to depression and suicide risk, with the secondary goal of improving understanding regarding these outcomes. FITBIR is a national repository of participant-level traumatic brain injury (TBI) data designed to address methodological limitations (e.g., small sample size, heterogeneity of injuries). METHOD: FITBIR studies with TBI severity and measures related to depression and suicidal ideation were identified. Data were harmonized across relevant studies and grouped to identify "probable depression" and suicidal ideation, resulting in a large, combined sample. Rates of probable depression and suicidal ideation were described across the available studies, considering the influence of demographic and/or injury-related factors on outcomes. RESULTS: Cross-sectional studies meeting criteria included four studies with depression outcomes and two with suicidal ideation outcomes. Two studies reported data appropriate for comparative analyses on depression. Combined results suggested that approximately 71% of participants were categorized as having probable depression. Participants with a history of mild TBI had 2.54 greater odds of probable depression (95% confidence interval [1.93, 3.34]) than those without a history of TBI. CONCLUSIONS: Methods, harmonization code, and meta-databases related to TBI, probable depression, and suicidal ideation are now publicly available on the FITBIR website. Even with limited data, harmonization of FITBIR studies can serve as the basis for ongoing TBI and mental health research. Analyses will be more robust in the future as more studies with relevant outcome data are added to the FITBIR database. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Inactivation of high-risk flags for suicide in the Veterans Health Administration: Association of documentation variation with suicide attempts.

Medical record high-risk flags for suicide indicate patients are receiving enhanced care and alert treating providers to patients' high-risk status. Risk of suicide mortality remains high after flag inactivation, suggesting a need to improve inactivation determinations. This study describes variation in flag inactivation documentation, examines whether documentation varies by patient or facility characteristics, and explores the association between inactivation documentation type and subsequent suicide attempts. In a national sample of veterans with a documented suicide attempt who received a high-risk flag for suicide (n = 224), medical record review was used to categorize provider documentation of the rationale and procedures for high-risk flag inactivation. Mixed-effects logistic regression models were used to examine patient and facility characteristics associated with flag inactivation documentation type and to examine the association between documentation type and subsequent suicide attempts. Flag inactivation documentation fell into one of two categories: documentation stating the patient no longer met criteria for the high-risk flag (minimal documentation; n = 98, 43.8%); and documentation that included a review of one or more criteria for high-risk flag inactivation (more than minimal documentation; n = 126, 56.3%). Flag inactivation documentation was not associated with patient or facility characteristics. Veterans with minimal documentation (vs. more than minimal) were more likely to have a suicide attempt after flag inactivation (adjusted odds ratio, AOR = 2.20; 95% CI [1.01, 4.78]; p = .046). Findings suggest a need to better understand flag inactivation procedures in place and to develop a set of standardized procedures to reduce risk of premature high-risk flag inactivation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).