Rocky Mountain MIRECC - Claire Hoffmire PhD - MIRECC / CoE
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Rocky Mountain MIRECC - Claire Hoffmire PhD

Rocky Mountain MIRECC for Veteran Suicide Prevention

Updated: 23 July 2018


Claire HoffmireClaire Hoffmire PhD
Title: Epidemiologist, Heath Science Specialist
Biography: Claire A. Hoffmire, Ph.D. is an Epidemiologist, working in the field of suicide prevention at the Department of Veterans Affairs since 2012. Dr. Hoffmire directs and works on both operations projects for the VA Office of Mental Health and Suicide Prevention, and investigator-initiated research projects. Dr. Hoffmire has extensive expertise working with VA national data, including VHA clinical and administrative records, the VA Suicide Prevention Application Network (SPAN) and the VA-DoD Suicide Data Repository (SDR). Dr. Hoffmire’s active research interests include enhancing Veteran suicide and non-fatal suicidal self-directed violence surveillance efforts, public health and upstream approaches to Veteran suicide prevention, and tailoring suicide prevention efforts to high-risk Veteran subgroups, in particular Women and non-VHA Veterans.

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Selected Publications

Kessler RC, Hwang I, Hoffmire CA, McCarthy JF, Petukhova MV, Rosellini AJ, Sampson NA, Schneider AL, Bradley PA, Katz IR, Thompson C, Bossarte RM. Developing a practical suicide risk prediction model for targeting high-risk patients in the Veterans Health Administration. IJMPR 2017; 26(3): e1575.
OBJECTIVES: The US Veterans Health Administration (VHA) has begun using predictive modeling to identify Veterans at high suicide risk to target care. Initial analyses are reported here. METHODS: A penalized logistic regression model was compared with an earlier proof-of-concept logistic model. Exploratory analyses then considered commonly-used machine learning algorithms. Analyses were based on electronic medical records for all 6,360 individuals classified in the National Death Index as having died by suicide in fiscal years 2009-2011 who used VHA services the year of their death or prior year and a 1% probability sample of time-matched VHA service users alive at the index date (n = 2,112,008). RESULTS: A penalized logistic model with 61 predictors had sensitivity comparable to the proof-of-concept model (which had 381 predictors) at target thresholds. The machine learning algorithms had relatively similar sensitivities, the highest being for Bayesian additive regression trees, with 10.7% of suicides occurred among the 1.0% of Veterans with highest predicted risk and 28.1% among the 5.0% of with highest predicted risk. CONCLUSIONS: Based on these results, VHA is using penalized logistic regression in initial intervention implementation. The paper concludes with a discussion of other practical issues that might be explored to increase model performance. Copyright © 2017 John Wiley & Sons, Ltd. KEYWORDS: assessment/diagnosis; clinical decision support; epidemiology; machine learning; predictive modeling; suicide/self harm
Hoffmire C; Stephens B; Morely, S; Thompson, C; Kemp, J; Bossarte, R. VA Suicide Prevention Applications Network: A National Health Care System-Based Suicide Event Tracking System. In Press. Public Health Reports.
Abstract not currently available
Bullman T, Hoffmire C, Schneiderman A, Bossarte R. Time Dependent Gender Differences in Suicide Risk Among OEF/OIF Veterans. Annals of Epidemiology. 2015; 25(12): 964-965.
Previous research has identified increased risk of suicide during the first three years after separation from active duty service [1]. Research to date has not addressed whether the pattern of suicide risk by time since separation differs by gender. Accordingly, this study examined gender-specific suicide risk in the period after separation from the military between 2002 and 2011.
Hoffmire CA, Kemp JE, Bossarte RM. Changes in Suicide Mortality for Veterans and Nonveterans by Gender and History of VHA Service Use, 2000-2010. Psychiatry Services 2015; 66(9):959-65.
OBJECTIVE: Veterans are believed to be at high risk of suicide. However, research comparing suicide rates between veterans and nonveterans is limited, and even less is known regarding differences by history of Veterans Health Administration (VHA) service use. This study directly compared veteran and nonveteran suicide risk while for the first time differentiating veterans by VHA service use.METHODS: The cross-sectional study analyzed data from 173,969 adult suicide decedents from 23 states (2000-2010) included in the U.S. Department of Veterans Affairs suicide data archive. Annual standardized mortality ratios (SMRs) were computed for veterans compared with nonveterans and for veterans who used VHA services compared with veterans who did not, overall and separately for males and females.RESULTS: After the analysis controlled for age and gender differences, the number of observed veteran suicides was approximately 20% higher than expected in 2000 (SMR=1.19, 95% confidence interval [CI]=1.10-1.28), and this increased to 60% higher by 2010 (SMR=1.63, CI=1.58-1.68). The elevated risk for female veterans (2010 SMR=5.89) was higher than that observed for male veterans (2010 SMR=1.54). Trends for non-VHA-utilizing veterans mirrored those of the veteran population as a whole, and the SMR for VHA-utilizing veterans declined. Since 2003, the number of suicides among VHA-utilizing veterans was less than expected when compared directly with the suicide rate among non-VHA-utilizing veterans. CONCLUSIONS: Veterans are members of the community and, as such, are an important part of observed increases in U.S. suicide rates. Not all veterans are at equal or increasing risk of suicide, however. VHA-utilizing veterans appear to have declining absolute and relative suicide rates.
McCarten JM, Hoffmire CA, Bossarte RM. Changes in Overall and Firearm Veteran Suicide Rates by Gender in 23 U.S. States, 2001-2010. AJPM 2015; 48(3):360-4.
This study aimed to provide novel information on overall and firearm-specific suicide rates among the broad veteran population, which includes both veterans who do and do not utilize VHA services. Suicide rates were computed and compared over time from 2001 to 2010. Furthermore, given documented differences in suicide mechanisms among men and women,4,6 mechanism-specific rates of suicide were calculated for male and female veterans independently.
Kopacz, M. S., Hoffmire, C. A., Morley, S. W., & Vance, C. G. (2014). Using a Spiritual Distress Scale to Assess Suicide Risk in Veterans: An Exploratory Study. Pastoral Psychology 2014; 64(3):381-390.
This exploratory study (1) examined the ability of a spiritual distress scale used by chaplains to identify Veterans with certain suicide risk factors and (2) provided an initial assessment of the reliability and validity of this scale to screen for Veterans at increased risk of suicide based on the presence of these risk factors. The scale consisted of five questions examining the presence or absence of guilt, sadness or grief, anger or resentment, despair or hopelessness, and feeling that life has no meaning or purpose. The scale was analyzed using Chronbach’s α-coefficient, factor analysis, Student’s t-tests, and logistic regression. Cut-off values were determined using the maximum Youden statistic. The five questions had a high level of internal consistency (α =0.88). Factor analysis suggested the presence of a common underlying factor, with correlations ranging from 0.42 to 0.78. Those identified with a suicide risk factor had significantly higher mean composite scores on this scale. Further, scores were significantly associated with increased odds of being identified with a suicide risk factor. A score ≥10 may be best suited for differentiating between individuals with and without certain suicide risk factors. This scale shows promise for identifying Veterans who may be at increased risk of suicide.
Hoffmire CA, Bossarte RM. A Reconsideration of the Correlation between Veteran Status and Firearm Suicide in the General Population. Injury Prevention 2014;20(5):317-321.
BACKGROUND: The relationship between veteran status and firearm suicide has been evaluated previously, but multiple sources of bias limit conclusions. This study aimed to clarify the relationship between a history of military service and firearm suicide. METHODS: Data obtained from suicide death certificates from nine states (1999-2009) were analysed. History of military service was validated using data obtained from the Department of Veterans Affairs and Department of Defense. Modified Poisson Regression with robust SEs was used to compute adjusted prevalence ratios for the common outcome of firearm use among suicide decedents. RESULTS: Male veteran suicide decedents were 6% more likely to use firearms, and female veteran suicide decedents were 18% more likely to use firearms compared with their non-veteran peers. CONCLUSIONS: Prior estimates based on logistic regression and death certificate reporting of veteran status may have overestimated the relationship between veteran status and firearm use among suicide decedents.
Hoffmire CA, Piegari RI, Bossarte RM. Misclassification of Veteran Status on Washington State Death Certificates for Suicides from 1999 to 2008. Annals of Epidemiology 2013;23(5):298-300.
This study aimed to quantify the misclassification, sensitivity, and specificity of veteran status overall and across demographic subgroups on Washington state suicide death certificates for 1999 to 2008 utilizing multiple sources, including VA and Department of Defense (DoD) records.
Hoffmire CA, R.C. Block, K. Thevenet-Morrison, E. van Wijngaarden. Associations between fish consumption and severity of depressive symptoms: an analysis of the 2005-2008 National Health and Nutrition Examination Survey. Leukotrienes & Essential Fatty Acids 2012;86(4-5):155-60.
Fish is the primary source of dietary omega-3 poly-unsaturated fatty acids EPA and DHA, which have been reported to reduce depressive symptoms in clinical trials. We assessed the association between fish consumption and depressive symptoms in a nationally representative sample of 10,480 adults from the 2005-2008 National Health and Nutrition Examination Survey. Depressive symptoms were classified by severity using the Patient Health Questionnaire. Fish meal consumption reported in 30-day food frequency questionnaires, and EPA+DHA intake computed from 24-h dietary recalls were evaluated in relation to depressive symptoms using multivariable ordinal logistic regression. Consumption of breaded fish showed an increased risk of greater depressive symptom severity, while all fish, non-breaded fish, and shell fish were not associated. Any EPA+DHA intake was significantly associated with fewer depressive symptoms. Exposure-response analyses revealed no clear patterns for any intake measures. Inconsistent patterns of associations in our study may be partially explained by exposure misclassification.

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Selected Studies

Coming Home from Afghanistan and Iraq
The Coming Home from Afghanistan and Iraq study will help VA understand the effects of military service, deployment, and combat on the health and well-being of Veterans who served during Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND). Researchers are looking at the physical and mental health, vocation or occupation, and social relationships of deployed Veterans, non-deployed Veterans, and similar civilians. Learn more

Assessing Social and Community Environments with National Data (ASCEND) for Veteran Suicide Prevention (MPI)
The overarching goal of this VA OMHSP operations funded project is to develop, design, and implement a reoccurring national survey of Veterans (ASCEND) that will: (1) Serve as a national surveillance system to document prevalence and trends over time in non-fatal suicidal self-directed violence (NF-SSDV; i.e., suicide ideation [SI] and suicide attempt [SA]) across the life course (e.g., lifetime, post-military service, past-year); and (2) Provide estimates of the impact of social and community risk and protective factors (e.g., social determinants of health, social capital, and interpersonal needs) on SI and SA among Veterans. This project focuses on the Veteran population as a whole, not only those using VHA services, and will inform policy and service development, program evaluation, and quality improvement for Veteran suicide prevention.

Identifying Novel Opportunities for Suicide Prevention among Women Veterans using Reproductive Health Care Services (PI)
The overarching goal of this VA HSR&D funded study is to determine whether reproductive health care settings offer an acceptable and effective setting to implement evidence-based, upstream suicide prevention strategies for Women Veterans. In this mixed-methods cohort study, we will use information from VHA patient medical records supplemented with primary data obtained from patient survey and semi-structured interviews to evaluate the magnitude of suicide risk and estimate the prevalence of suicide risk and protective factors among Women Veterans 18 to 44 years of age who use VHA reproductive health care services. We will also assess Women’s beliefs, attitudes, and preferences regarding suicide risk assessment and prevention within reproductive health care settings.

Patient Safety Center of Inquiry-VA Suicide Prevention Collaborative (PSCI-VASPC) (Co-I)
The overarching goal of this project is to create a VA PSCI focused on developing, implementing, and evaluating practical solutions to reduce suicide among Veterans who are not receiving VA care. This center is organizationally affiliated with the Central Texas VA Healthcare System.

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