1066 — Improving Suicide Prevention for Women Veterans: Recommendations from VHA Suicide Prevention Coordinators

Lead/Presenter: Lauren Krishnamurti, 
All Authors: Krishnamurti LS (Center for Health Equity Research and Promotion, Pittsburgh), Agha A (Center for Health Equity Research and Promotion, Philadelphia) Beyer N (Center for Health Equity Research and Promotion, Pittsburgh) Denneson L (Center to Improve Veteran Involvement in Care, Portland) Dichter ME (Center for Health Equity Research and Promotion, Philadelphia)

Objectives:
Women are a minority Veteran subpopulation experiencing particular risk for suicide and facing distinct challenges in accessing Veterans Health Administration (VHA) care. As part of efforts to enhance suicide prevention, the VHA established Suicide Prevention Coordinators (SPC) as clinicians who work exclusively to connect high-risk Veterans to the scope of VHA’s services. As SPCs are commonly a key liaison between Veterans and other VHA providers, they have a valuable perspective on how the care needs of women Veterans intersect with the cultural and structural barriers women face in navigating and using VHA clinical care. Therefore, the aim of this study was to understand where they see differences in the care needs and preferences of women, and where they recommend changes be made at both the cultural and structural level. This study presents findings from qualitative interviews with SPCs regarding the care needs, preferences, and concerns of women Veterans who utilize VHA for enhanced suicide-related care.

Methods:
Utilizing a semi-structured interview guide, we conducted qualitative interviews with 20 SPCs from 13 VAMCs around the United States between May and August 2021. We specifically asked SPCs to share their perspectives on women Veterans’ barriers to accessing care and their recommendations to improve suicide prevention for this subpopulation. Once data was transcribed, we conducted a thematic content analysis to extract key themes.

Results:
SPCs revealed that some women Veterans opt to avoid VHA due to prior negative experiences, often related to perceptions about provider sensitivity to women’s issues. Safety was another key concern, specifically related to women voicing that they feel unwelcome or intimidated in the male-dominated Veteran community, as well as in the physical spaces of the VA. Key provider recommendations include increasing the availability and diversity of gender-sensitive providers, including more LGBTQ+ providers and providers of color, as well as making changes to the physical spaces of the VHA to better facilitate women Veterans’ comfort and overall access to care.

Implications:
SPCs underscored the importance of comfort and relatability between women Veteran patients and providers, especially in relation to enhanced care for suicide risk. This study presents important evidence in support of enhancing suicide prevention in more upstream ways by better engaging women Veterans in care that is more visibly inclusive and sensitive to their experiences and identity, in and outside VHA.

Impacts:
This study highlights important areas of focus for integrating upstream suicide prevention for women Veterans. Provider recommendations reveal the importance of strengthening women’s trust in the VA as a means of enhancing care access and thus reducing suicide risk among this population.