Inaccurate Disclosure of Suicidal Thoughts During Population-Based Suicide Risk Screening in Primary Care in the Veterans Health Administration.

Background: Prior research suggests that disclosure of suicidal thoughts in healthcare settings may be low.

Objectives: Describe frequency of self-reported inaccurate disclosure of suicidal ideation during population-based screening and evaluation in primary care and identify patient characteristics associated with inaccurate disclosure.

Design: National survey study examining veteran experiences with the Veterans Health Administration's (VHA) suicide risk screening program, Risk ID.

Participants: A national sample of 2001 veterans screened in primary care between February and October 2021 were mailed surveys. Eight-hundred sixty-eight surveys were returned, and 734 respondents recalled being screened.

Main measures: Several survey items which asked to what extent respondents had accurately responded to clinicians or nurse/medical assistants when asked about suicidal thoughts.

Key results: Fourteen percent and 18% of screen-negative participants and 40% and 48% of screen-positive participants reported responding less than very accurately to questions about suicidal thoughts when asked by nurses/medical assistants and providers, respectively. Among screen-negative participants, factors associated with inaccurate disclosure included being Black, American Indian/Alaska Native, Hispanic, Asian, or Multi-racial; higher levels of psychological distress and greater barriers to care; and lower ratings of the clinician-patient relationship. Factors associated with inaccurate disclosure in screen-positive participants included greater barriers to care, perceptions that screening questions did not make sense, perceptions that they would not be taken seriously, and lower ratings of satisfaction with the screening process.

Conclusion: Inaccurate disclosure during VHA population-based suicide risk evaluation is not uncommon. Patients who are Black, American Indian/Alaska Native, Hispanic, Asian, or Multi-racial, are in more distress, report more barriers to care, or are less satisfied with the screening process may be less likely to disclose accurately. The results highlight that clinicians should not overly rely on screening results for clinical decision-making, and reinforce the value of strong clinician-patient treatment relationships and positive screening experiences in promoting accurate disclosure.