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Additional research is needed to best reach and intervene with women Veterans at risk for suicide.
- Recent data point to concerning trends in Veteran suicide rates among women as compared to to men.
- Research shows that there has been an increase in the proportion of suicides by firearms among women.
- These findings demonstrate the need to develop evidence-based interven- tions for promoting firearm safety among women.
Recent data from the 2016 VA report, “Suicide among Veterans and other Americans:
2001-2014,” demonstrate the importance of understanding suicide risk among women Veterans and developing gender-tailored suicide prevention strategies. Among Veterans, the 2014 suicide rate for women was 19 per 100,000. Although this rate is lower than that observed for men (37 per 100,000), there is concern regarding the more rapid increase in Veteran suicide rates between 2001 and 2014 among women as compared to men; a 62 percent increase versus a 30 percent increase, respectively. Furthermore, the excess suicide risk for Veterans compared to civilians is much higher among women (250 percent, 2014) than among men (19 percent, 2014). Firearms are more commonly used as the mechanism of suicide among Veterans for both women (41 percent) and men (68 percent), as compared to civilians (31 percent and 52 percent, respectively). Notably, women Veterans were the only group for whom the proportion of suicides by firearm increased between 2001 and 2014 (from 36 percent to 41 percent).
These data suggest that although firearm use is not likely to fully explain the excess risk of suicide among women Veterans, the increasing use of firearms among women Veterans is concerning and indicates an opportunity to increase evidence-based interventions promoting firearm safety among women Veterans. Finally, time trends in suicide risk following military service may vary by gender. Findings from one study of Operation Enduring Freedom/Operation Iraqi Freedom Veterans suggest that while suicide risk declines significantly for men during the first seven years post-separation, this is not the case for women, for whom the risk for suicide remains elevated.1
Despite these trends, the majority of research examining suicide risk among Veterans has been sex and gender neutral; few studies have examined how gender might impact Veterans’ risk for suicide or how risk assessment and prevention approaches could be tailored to account for differences in risk and treatment response. One practical reason for this is that the low base rate of suicide among women, coupled with the relatively low proportion of women in the Veteran population (10 percent in 2014), makes studying suicide among women Veterans challenging. Accordingly, our current understanding of suicide risk and resilience among Veterans is largely based on studies of men, with only a few emerging trends to suggest that some health and psychosocial factors might be higher-priority intervention targets among women than men.
Although strong social ties are thought to be an important protective factor more broadly, tenuous or unsupportive relationships may be especially concerning for women Veterans as women tend to rely more on social supports to cope with stress and more frequently experience psychological and physical harm from social integration than men.2,3 Specifically, past or current physical or sexual abuse, including military sexual trauma, may increase the risk of Veteran suicide among women more so than among men.4 Another area that has received attention is substance abuse, though findings to date have been mixed regarding gender differences in the association between substance use disorders and suicide risk. One recent analysis of VA data indicates that the strong association between substance abuse and suicide risk among women Veterans might be explained by other, comorbid mental health conditions.5 Meanwhile, a growing body of literature in women’s health indicates the importance of gender-sensitive, coordinated care for women Veterans more broadly, which might be especially important for women who are at risk for suicide.
In recognition of the elevated and increasing suicide rate in the Veteran population, the outgoing VA Secretary recently named suicide prevention as VA’s number one clinical priority. The epidemiologic trends in rates, use of firearms, and risk over time observed among women Veterans suggest that we must incorporate gender into suicide prevention work to rapidly increase our knowledge of suicide risk and resilience across the life course, as well as strategies to tailor firearm safety efforts, for women Veterans. Although published research to date investigating gender differences in suicide risk and treatment response among Veterans is quite limited, this and other work in women’s health point towards the need to identify specific programs and settings to best reach and intervene with women Veterans at risk for suicide.
- Bullman T, Hoffmire C, Schneiderman A, et “Time Dependent Gender Differences in Suicide Risk among Operation Enduring Freedom and Operation Iraqi Freedom Veterans,” Annals of Epidemiology 2015; 25:964-65.
- Taylor SE, Klein LC, Lewis BP, et “Biobehavioral Re- sponses to Stress in Females: Tend-and-befriend, not Fight-or-flight,” Psychological Review 2000; 107:411.
- Kawachi I, Berkman “Social Ties and Mental Health,” Bulletin of the New York Academy of Medicine 2001; 78:458-67.
- Kimerling R, Makin-Byrd K, Louzon S, et “Military Sex- ual Trauma and Suicide Mortality,” American Journal of Preventive Medicine 2016; 50:684-91.
- Bohnert KM, Ilgen MA, Louzon S, et “Substance Use Disorders and the Risk of Suicide Mortality among Men and Women in the US Veterans Health Administration,” Addiction 2017; 112(7):1193-1201.