How to Stratify Suicide Risk in Veterans With PTSD
How can clinicians classify Veterans with PTSD into the suicide risk tiers used in this study?
Veterans with PTSD have elevated suicide risk, but risk classification can be difficult in routine care. This study used the VA Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (RV) algorithm to define high-, moderate-, and low-risk groups and then examined how psychotherapy note content differed across those tiers.
-
Confirm the patient meets the PTSD definition used in the study
Identify Veterans with PTSD using documented ICD diagnoses. In this study, PTSD was defined as at least 2 PTSD diagnostic codes in the prior 2 years, using ICD-9 code 309.81 or ICD-10 codes beginning with F43.1, to ensure consistent documentation.
-
Obtain the current RV suicide risk score
Use the VA Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment algorithm to determine the patient's suicide risk score. The article describes RV as a machine learning-derived prediction model that uses structured EHR variables including service use, psychotropic medication use, diagnoses, prior suicide attempts, and sociodemographics.
-
Assign the risk tier from the RV score
Classify the patient as high risk if the RV score is 0 to 1, moderate risk if the score is 2 to 24, and low risk if the score is 25 to 100. These are the exact thresholds the investigators used to define the three suicide risk groups.
-
Interpret psychotherapy patterns in the context of risk tier
Use the assigned tier to frame expectations about care patterns rather than to infer treatment efficacy. In this study, higher-risk groups showed less Risk, Treatment Planning, and Medication topic presence and more Psychosocial topic presence than lower-risk groups, with Evaluation also decreasing from moderate- to high-risk patients.
Clinical Considerations
- The RV model is a VA-specific algorithm built from structured EHR variables and the findings should not be generalized to civilian populations.
- Because RV includes mental health service utilization variables, higher-risk groups in this framework may also have higher session counts by design.
- The study used ICD-based PTSD identification rather than standardized PTSD assessment scores, so different case-finding methods could yield different populations.
Bottom Line
In this study, Veterans with PTSD were stratified by RV score into high risk 0 to 1, moderate risk 2 to 24, and low risk 25 to 100, and those tiers meaningfully corresponded to different psychotherapy documentation patterns.
