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2023 HSR&D/QUERI National Conference Abstract

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1025 — An Emerging Population at High Risk for Suicide by Firearm: Characteristics of Women Reserve and National Guard Veterans Who Have Guns in their House

Lead/Presenter: Michelle Mengeling,  COIN - Iowa City
All Authors: Sadler AG (Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System; University of Iowa Carver College of Medicine, Department of), James C. Torner (University of Iowa College of Public Health, Department of Epidemiology; University of Iowa Carver College of Medicine, Department of Neurosurgery); Brian L. Cook (Iowa City VA Health Care System; University of Iowa College of Medicine, Department of Psychiatry); Jeffrey Smith (Central Arkansas Veterans Health Care System; Department of Veterans Affairs Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, North Little Rock , AR); Alison Hamilton (Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System; University of California Los Angeles, Department of Psychiatry and Biobehavioral Sciences); Jonathan Platt (University of Iowa College of Public Health, Department of Epidemiology); Michelle A. Mengeling (Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System; University of Iowa Carver College of Medicine, Department of Internal Medicine)

Objectives:
Women Veterans and Reserve and National Guard (RNG) servicemembers deployed post-9/11 are among the fastest growing groups of Veterans using VA health care. Actively serving RNG are emerging as a population at high risk for suicide, and firearms are women Veterans’ leading method of suicide deaths. Unfortunately, little is known about suicide risk characteristics or gun ownership/access among RNG women Veterans.

Methods:
A national community sample of women RNG Veterans was identified. Using a cross-sectional study design, participants (N = 341) completed a semi-structured telephone interview that queried socio-demographic, military, trauma exposure, mental health, care utilization, and gun ownership characteristics. We describe gun ownership (e.g., number, types, reasons for owning) and identify characteristics associated with gun ownership, including suicide risk, using Chi-square statistics (p < .05).

Results:
Over half of women RNG Veterans personally owned guns (N = 187, 54%) with nearly half (49%) having 3 or more guns in their household. Most (83%) reported having guns for self-protection, 54% reported feeling more in control with a gun, and 44% had guns due to nightmares, not mutually exclusive. Over two-thirds had guns in their household either through ownership or cohabitation with a gun owner (N = 233, 68%). Two-thirds of women with guns in household disagreed or strongly disagreed that providers should ask about gun ownership (64%). Women with guns in their household were more likely than peers without guns to be: white, live in rural areas, currently serving in RNG, currently married/partnered, and for their partner to have military service and Iraq/Afghanistan deployments. Women with guns in their household were more likely to have experienced seeing someone wounded, killed or dead in combat; to acknowledge housing insecurity; and to screen positive for alcohol use disorder (AUDIT-C) and for higher risk suicide behaviors (Suicide Behaviors Questionnaire-R).

Implications:
The majority of RNG women Veterans had one or more guns in their household, most often for the purposes of self-protection. Rural Veterans and white Veterans, as well as those actively serving in the RNG emerged as sub-populations more likely to have guns. Of great concern, women with guns in their household were more likely than peers without guns to screen at higher suicide risk and for alcohol use disorder, to have loaded and readily accessible guns, and they did not believe that providers should ask them about gun ownership. Identifying these specific characteristics of women RNG women Veterans’ gun ownership is an important initial step in guiding safety efforts and suicide risk-mitigation. Further research is needed to understand RNG women Veterans’ gun ownership while mitigating their safety and suicide risk given that these women do not want to discuss gun ownership with their providers

Impacts:
Current gun safety and suicide risk mitigation efforts may not adequately address the unique needs or preferences of high-risk RNG women Veterans, and moreover rural and actively serving RNG subpopulations. Interventions must consider multiple gun households, RNG women Veterans’ use of guns for self-protection and control, and their accessibility to and potential risks from cohabitants’ firearms.