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New QUERI Partnered Evaluation Initiative on Suicide Prevention: Bridging the Deadly Gap

The United States is experiencing a national epidemic of suicide among its youngest Servicemembers who are still serving in the Department of Defense and those who have transitioned out of the military. Veterans face the highest risk of suicide during the first year after they exit the military—a year that has become known as the “deadly gap,” when Veterans have left behind the structure and supports that they experienced in the military, and transition to civilian life.

VA’s Veteran Sponsorship Initiative+ (VSI+) is a precision medicine approach to suicide prevention that addresses the suicide risk factors for Servicemembers as they transition into civilian life. VSI+:

• Uses predictive analytics to identify Servicemembers at high risk for suicide.
• Contacts identified high-risk Servicemembers and connects them—before they leave the service—to stepped-care interventions, beginning with a VA certified and community-based peer sponsor in their post-military community.
• Connects identified high-risk Veterans to additional help, including streamlined access to VA healthcare and other relevant services from community partners in the Veteran Sponsor Partnership Network.

QUERI’s Evaluation of the VSI+

Recently, QUERI funded an evaluation of the VSI+, led by Joseph Geraci, PhD, of the VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC) and the VISN 17 Center of Excellence for Research on Returning War Veterans, in collaboration with the VHA National Center for Healthcare Advancement and Partnerships. From 2024 to 2027, the evaluation will examine the VSI+ program’s effectiveness and implementation, with sequential rollout to participating military installations over time while using other installations as controls until they begin implementation. This stepped-wedge design will allow for extended implementation support to the maximal number of installations and will support future scale-up and spread.

QUERI’s evaluation of VSI+ aims to:

• Determine the effectiveness of the VSI+ as evidenced by measures of reintegration difficulties, social support, depression, suicidal ideation and behaviors, and VA/non-VA service utilization.
• Determine the feasibility and potential utility of implementing the VSI+ on four military installations. Servicemembers who transition from installations without VSI+ will experience their transition from military to civilian life as usual (i.e., with services from the U.S. Army Transition Assistance Program).
• Estimate the impact of VSI+ on healthcare costs.