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2015 HSR&D/QUERI National Conference Abstract

1015 — OEF/OIF Veterans' Experiences with Suicidal Ideation: Implications for Intervention

Denneson LM, Portland Center to Improve Veteran Involvement in Care (CIVIC); Teo AR, Portland Center to Improve Veteran Involvement in Care (CIVIC); Ganzini L, Portland Center to Improve Veteran Involvement in Care (CIVIC); Helmer DA, War-Related Illness and Injury Study Center, VA New Jersey Health Care System; Bair MJ, Richard L. Roudebush Veteran Affairs Medical Center; Dobscha SK, Portland Center to Improve Veteran Involvement in Care (CIVIC);

Research on Veteran suicide often relies on VA administrative, state mortality, or other quantitative data. This top-down approach does not adequately describe Veterans' perspectives on suicide or the underlying reasons for contemplating suicide, leaving important gaps in our understanding of how to effectively intervene with Veterans at risk. In this qualitative study, we sought to understand Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans' perceptions of suicidal ideation (SI) and circumstances leading up to SI.

At three large Veterans Affairs medical centers, we conducted semi-structured, qualitative interviews with 34 OEF/OIF Veterans who had endorsed SI in response to brief structured SI assessments administered in ambulatory clinics. Sampling was purposive to recruit adequate representation of men and women and a range of races/ethnicities and age. Veterans were asked about the circumstances leading up to the time of SI endorsement and their perceptions of the healthcare response to their SI. Coding and analysis focused on perspectives of suicidal thoughts and behaviors as well as the circumstances contributing to the development of SI. Analysis was conducted using an iterative, inductive and deductive thematic analysis approach.

Results revealed three pervasive domains that reinforce the uniqueness of OEF/OIF Veteran suicidal thoughts: military culture, difficult deployment experiences, and post-deployment adjustment challenges. Within post-deployment adjustment, we identified four themes that represented the most salient challenges facing these Veterans: adjusting to civilian culture, changes to sense of self, feeling overwhelmed by stressors, and lacking life purpose or meaning.

Suicide prevention efforts among OEF/OIF Veterans should fit within - and be sensitive to - military and Veteran cultures. Interventions that focus on enhancing a sense of purpose or meaning in life and improving post-deployment adjustment and reintegration may be particularly beneficial for newly returning Veteran populations experiencing SI.

This work augments the larger body of quantitative research on suicide risk and intervention among returning Veterans and suggests a novel framework for intervention development.