Takeaway: Findings from this study will provide previously unavailable evidence to support the selection of intervention targets – and to identify high-priority services and barriers to care for female Veterans at risk for fatal and non-fatal suicide attempts. This work also has the potential to benefit the broader population of female Veterans at risk of suicide.
The suicide rate among female Veterans increased 63% between 2000 and 2014, which was significantly higher than the 30% increase observed among male Veterans during this period. Despite a large volume of work examining risk factors, barriers to care, and care utilization among Veterans, little research has examined these issues as they relate to females. Available research has been limited by small female sample sizes, cross-sectional analysis, and other methodological limitations. As such, we know surprisingly little about the health and psychosocial factors, barriers to care, and healthcare utilization patterns associated with suicidal behaviors among female Veterans. However, data on female risk for suicide and their healthcare utilization is needed to direct valuable suicide prevention resources and help VHA address this growing concern.
This ongoing study (May 2018 – April 2023) will focus on a large, national sample of female and male Veterans with recent non-fatal suicidal self-directed violence (SSV: fatal and non-fatal suicide attempts), and aims to:
- Develop and test explanatory models of female and male risk for repeat SSV over 12 months, and
- Identify similarities and differences in patterns of healthcare use, coping strategies, and symptom change over time between female and male Veterans at risk for SSV.
This is a mixed-methods, longitudinal cohort study, which is guided by a public health, social-ecological framework to facilitate examination of the range of risks for SSV. Investigators have enrolled 25 female and 25 male Veterans for whom a non-fatal SSV event was recorded in a VA suicide behavior report. These 50 Veterans participated in qualitative interviews to gather data on:
- Veterans' perspectives and experiences with suicidal thoughts and SSV;
- Recovery needs and experiences with the recovery process, barriers and facilitators to care; and
- How clinicians and the healthcare system could better identify and address the needs of Veterans like them.
For the longitudinal survey, investigators will use VA data to identify and enroll at least 480 female and 480 male Veterans, who will complete health and psychosocial measures at baseline, 6- and 12-month follow up. Self-report questionnaires will include psychosocial and health-related measures such as coping efficacy, interpersonal conflict, positive relations with others, trauma, occupational problems, barriers to care, and mental health symptoms. Participants will be followed for 12 months to assess and document all SSV events (primary outcome: an SSV event following baseline).
Qualitative analysis revealed two gendered narratives of suicidal thoughts and attempts that incorporated the primary themes of self-concept, social power, relationships, coping, and stress. When discussing reasons for their suicide attempts, women Veterans discussed negative self-evaluative processes describing themselves as, “shameful,” “tainted,” and “worthless,” whereas men discussed becoming overwhelmed, and recalled thinking, “it just wasn’t worth it,” “I’ve had enough,” and, “screw this.” Prevention or recovery needs also were described differently. While women tended to find it more important to learn from, be supported by, and provide support to others, men spoke more frequently about living “right” to become their best selves. Men also wanted to feel like they were needed by others. Both women and men wanted to feel a stronger sense of purpose in their lives.
Findings from this study will provide previously unavailable evidence to support the selection of intervention targets as well as identify high-priority services and barriers to care to direct programming and research priorities for female Veterans at risk for SSV. This work has the potential to also benefit the broader population of female Veterans with mental health conditions or other risk factors for SSV.
Principal Investigator: Lauren Denneson, PhD, Core Investigator with HSR&D’s Center to Improve Veteran Involvement in Care (CIVIC), and investigator with HSR&D’s Suicide Prevention Impact Network (SPRINT).
Denneson L, Hoffmire C, Blosnich J, et al. Advancing knowledge of suicide risk and prevention among women: Introduction to the Supplement. Medical Care. February 1, 2021;59:S1-S3.
Denneson L, Tompkins K, McDonald K, et al. Gender differences in recovery needs after a suicide attempt: A national qualitative study of US military Veterans. Medical Care. February 1, 2021;59:S65-S69.
Chen J, Cameron D, Laliberte A, Hooker E, Niederhausen M, and Denneson L. Assessment of suicidal intent in self-directed violence and subsequent care received among military Veterans: A national study of gender differences. Medical Care. February 1, 2021;59:S17-S22.
Denneson L, Tompkins K, McDonald K, et al. Gender differences in the development of suicidal behavior among United States military Veterans: A national qualitative study. Social Science & Medicine. September 1, 2020; 260:113-178.
View study abstract