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首页> 外文期刊>BMJ quality & safety >Association between acute psychiatric bed availability in the Veterans Health Administration and veteran suicide risk: a retrospective cohort study
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Association between acute psychiatric bed availability in the Veterans Health Administration and veteran suicide risk: a retrospective cohort study

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Background Veteran suicides have increased despite mental health investments by the Veterans Health Administration (VHA). Objective To examine relationships between suicide and acute inpatient psychiatric bed occupancy and other community, hospital and patient factors. Methods Retrospective cohort study using administrative and publicly available data for contextual community factors. The study sample included all veterans enrolled in VHA primary care in 2011-2016 associated with 111 VHA hospitals with acute inpatient psychiatric units. Acute psychiatric bed occupancy, as a measure of access to care, was the main exposure of interest and was categorised by quarter as per cent occupied using thresholds of 95. Hospital-level analyses were conducted using generalised linear mixed models with random intercepts for hospital, modelling number of suicides by quarter with a negative binomial distribution. Results From 2011 to 2016, the national incidence of suicide among enrolled veterans increased from 39.7 to 41.6 per 100 000 person-years. VHA psychiatric bed occupancy decreased from a mean of 68.2 (IQR 56.5-82.2) to 65.4 (IQR 53.9-79.9). VHA hospitals with the highest occupancy (>95) in a quarter compared with 95) was associated with a 10 increased suicide risk for veterans whereas absolute number of beds was not, suggesting occupancy is an important access measure. Future work should clarify optimal bed occupancy to meet acute psychiatric needs and ensure adequate bed distribution.

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