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2023 HSR&D/QUERI National Conference Abstract

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4014 — Prevalence and Correlates of Suicidal Ideation and Suicide Attempt among Women Veterans Using VHA Reproductive Health Care Services

Lead/Presenter: Julie Kittel-Moseley,  Rocky Mountain MIRECC
All Authors: Kittel-Moseley JA (Rocky Mountain Mental Illness Research Education and Clinical Center, Denver), Monteith LL (Rocky Mountain Mental Illness Research Education and Clinical Center, Denver) Schneider AL (Rocky Mountain Mental Illness Research Education and Clinical Center, Denver) Miller C (Rocky Mountain Mental Illness Research Education and Clinical Center, Denver) Gaeddert LA (Rocky Mountain Mental Illness Research Education and Clinical Center, Denver) Brenner LA (Rocky Mountain Mental Illness Research Education and Clinical Center, Denver) Katon J (Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle) Hoffmire CA (Rocky Mountain Mental Illness Research Education and Clinical Center, Denver)

Objectives:
Women Veterans are at elevated risk for suicide compared to their civilian peers. Further, women Veterans experience a high prevalence of suicidal ideation (SI) and suicide attempt (SA), which elevate risk for suicide. Yet evidence-based, gender-sensitive suicide prevention programming is precluded by limited knowledge on correlates of SI and SA in this population. Specifically, information is lacking to identify settings and targets for upstream suicide prevention tailored to the needs and preferences of women Veterans. Reproductive health care (RHC) is among the most common services women seek, and women Veterans generally describe feeling comfortable discussing sensitive topics pertinent to suicide risk and prevention with RHC providers. Thus, RHC settings may be ideal for implementation of upstream suicide prevention initiatives. Accordingly, this study aimed to estimate the prevalence of post-military SI and SA among women Veterans using VHA RHC services and examined associations between SI and SA and parenting-related factors, fertility, pregnancy, and military sexual trauma (MST).

Methods:
Post-9/11 women Veterans (n = 352) who used VHA RHC services in the past year completed a cross-sectional survey of reproductive and mental health between December 2018 to April 2019. The survey included questions about SI and SA across the life course, parenting satisfaction and functioning, pregnancy and fertility history, MST, and mental health symptoms. Modified Poisson regression with robust standard errors was used to estimate prevalence ratios between these factors and post-military SI and SA as well as past-month SI, adjusting for military service and demographic characteristics and current mental health symptoms

Results:
Nearly 30% of survey respondents reported experiencing SI after military separation, and 9.9% reported experiencing SI in the past month. Further, 12.3% reported post-military SA and 69.1% of those with prior SA reported multiple attempts. Current parenting satisfaction was strongly associated with past-month SI after adjustment; women with low parenting satisfaction had 3.36 (95% CI: 1.19, 9.46) times the prevalence of SI compared to those with high parenting satisfaction. Parenting satisfaction was not significantly associated with SA. Pregnancy and infertility history were not associated with either SI or SA. Women Veterans who experienced military sexual harassment (MSH) had a higher prevalence of post-military SI (prevalence ratio [PR]: 2.08; 95% CI: 1.05, 4.11) compared to those with no history of MST. Military sexual assault (MSA) was also strongly associated with post-military SI (PR: 3.81;95% CI: 2.12, 6.84). MSA, but not MSH, was associated with post-military SA (PR: 3.84; 95% CI: 1.55, 9.53).

Implications:
A high proportion of women Veterans using VHA RHC services experience SI and SA following separation from military service. Women Veterans in these settings with low parenting satisfaction or with MST histories appear to be at particularly high risk.

Impacts:
These findings, coupled with prior research indicating women Veterans find RHC settings acceptable for suicide risk screening and prevention, suggest that VHA RHC settings present a novel opportunity to enhance upstream suicide prevention tailored to the needs of women Veterans. Assessment of parenting satisfaction and MST, particularly sexual assault, may be especially important for comprehensive suicide risk assessment and prevention in this population.