Clinician’s Corner: Shared Decision Making for PTSD
Last month, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) issued an updated Clinical Practice Guideline for the Management of PTSD.
I was enthusiastic to see that the very first recommendation in this guideline encourages health care providers to engage patients in shared decision making.
As a shared decision making researcher, I have found that most providers are on board with the idea of involving patients in PTSD treatment decisions, but they are often less clear about what shared decision should actually look like in practice or exactly how or why shared decision making is beneficial for patients. To help clarify these issues—and to hopefully inspire you to consider how you can better integrate shared decision making in your own clinical practice—this Clinician’s Corner column addresses some common questions about shared decision making and its role in the treatment of PTSD.
Military Matters: Suicide Prevention in the U.S. Army: Targeting Risk and Resilience
From a public health perspective, U.S. Army suicides are rare events and the prevalence of suicide in the U.S. Army is low (less than 0.02 percent). However, the impact of even one death, especially a suicide, has a resounding effect on America’s fighting force.
Since 2004, there has been an observed increase in the suicide rate among U.S. Army Soldiers. The U.S. Army’s highest number and rate of suicide among active-duty Soldiers was in 2012. In more recent years, 2013 to 2015, the U.S. Army suicide rate has stabilized and is approaching the rate seen in a matching U.S. population. While not as dramatic, the suicide count and rate in the U.S. general population has also increased in the last several years (Curtin, Warner, and Hedegaard, 2016).
Most risk factors for suicide among U.S. Army Soldiers are not unique to the military. Several studies have demonstrated that a myriad of circumstances, not one single factor, contribute to a person dying by suicide (Millner et al., 2017; Nock et al., 2017; Ursano et al., 2017). Among Soldiers, most suicide cases are young, junior enlisted, white, and male. In general, these characteristics have remained unchanged, but in recent years the rate of suicide among older Soldiers (25-34 years of age) has increased compared to younger Soldiers (17-24 years of age) (Nweke et al., 2016).