Clinical TMS in US veterans decreases measures that predict suicide risk – across VHA update

Background: The US Department of Veterans Affairs (VHA) identifies suicide prevention as a priority as data suggests veterans complete suicides at higher rates than the general population. A validated self-report measure of depression symptoms, the 9-item Patient Health Questionnaire (PHQ9), is routinely used throughout VHA as a screening tool. Two large-scale EMR/death registry studies by Simon et al (2013) and Louzon et al (2016) have established that higher levels of suicidal ideation as measured by PHQ9 item9 are associated with increasing risk of suicide in general populations and veterans, respectively. Moreover, Simon et al (2017) subsequently showed that a decrease in PHQ9-measured suicidal ideation was associated with decreased risk of suicide attempts over the following 90 days. At the 4th IBS conference we presented data showing that clinical TMS as practiced at a single VHA site (Pittsburgh, PA) decreased suicidal ideation as measured by PHQ9. In this follow-up investigation we evaluate a larger sample across 27 VHA sites. Methods: We performed a retrospective intention-to-treat, last-observation-carried-forward analysis of over 800 patients engaged in TMS treatment between 2017 and 2020, using only data obtained as part of routine care. PHQ9 total and PHQ9-item9 were included as response variables in separate mixed regression models with Treatment Phase (PreTMS, PostTMS) as fixed effect and Subject as random effect. Results: The proportion of TMS treated patients that were treatment Responders (=>50% decrease from PreTMS PHQ9 total score) or Remitters (postTMS PHQ9 total score < 5) was 33.9 and 15.9 percent, respectively. There were significant decreases in both total PHQ9 score and suicidal ideation with TMS treatment. Discussion: Clinical TMS as practiced across VHA likely decreased subsequent risk of suicide at least over the short term. Decreases in related depressive measures may also provide opportunity for further treatment engagement in these high-risk veterans. Research Category and Technology and Methods Clinical Research: 10. Transcranial Magnetic Stimulation (TMS) Keywords: Suicide, Veterans Health

Abstract licence: CC BY-NC

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