Veterans Crisis Line Gender Findings: Qualitative Interviews with Women Veterans

HSR&D’s monthly publication Veterans’ Perspectives highlights research conducted by HSR&D and/or QUERI investigators, showcasing the importance of research for Veterans – and the importance of Veterans for research.

In the November-December 2022 Issue:

• Introduction: Prior research has identified gender differences in suicide risk and reasons for contacting the Veterans Crisis Line.
• VCL Study: The Strengthening Suicide Prevention Efforts for Women Veterans through the Veterans Crisis Line study focuses on identifying VCL use and needs of women Veterans.
• Findings: A primary theme emerged regarding women Veterans preferring female responders.
• Impact and Implications: In-depth interviews were vital to researchers' understandings and participants' experience.

Introduction

Suicide rates among Veterans have increased in recent decades. VA has implemented a variety of programs to address the suicide prevention needs of Veterans, including launching the National Suicide Prevention Hotline in 2007, which was renamed the Veterans Crisis Line (VCL) in 2010. Women Veterans represent a growing population with unique needs and experiences; prior research has found gender differences in suicide risk as well as in reasons for contacting VCL. VCL is available for support with acute suicidal crises but also to address distress or resource needs that are not acutely related to suicide risk but may be more upstream concerns that, if left unaddressed, may lead to later suicidal ideation or self-harm.

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VCL Study

Strengthening Suicide Prevention Efforts for Women Veterans through the Veterans Crisis Line is an HSR&D-funded study with a focus on identifying the VCL use and needs of women Veterans. This study involves examination of VCL call data, suicide-related outcomes following VCL contacts, and perspectives and recommendations of women Veterans who have contacted VCL. As part of this study, researchers conducted one-on-one in-depth interviews with 26 women Veterans who had contacted VCL in the preceding year, asking about reasons for contacting VCL, experiences with VCL contact, and recommendations for strengthening VCL services specifically for women Veterans. Interviews were conducted via telephone and, with participant consent, audio-recorded and transcribed. Study researchers then analyzed the interview transcripts to identify themes within the data. Representing all areas of the country, 42% of participants were age 55 years or older; 35% were Black/African American, 42% were white, and 23% reflected other racial identities. Twelve percent were of Hispanic ethnicity.

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Findings

Interviews with women Veterans who had experience with contacting VCL revealed several themes regarding gender-specific considerations for VCL services.

1. A primary theme in the interviews involved the gender of the VCL responder – interview participants raised this as an important topic even when not prompted by the interviewer to address it. Veterans noted that women Veterans may prefer talking with another woman and might not be comfortable talking with a man. Sometimes this preference was due to wanting to talk about gender-specific experiences and feeling that a woman responder would be better able to understand those experiences.

   “A lot of times… if it’s a man, we just don’t want to reveal so much, we’re not willing to open up…”    

   “I didn’t want to call because I don’t want to talk to a male… it makes it uncomfortable sometimes to access a stranger that is male.”

   Interview participants also talked about the pervasive experience of sexual trauma and other harassment perpetrated by men that led them to feel triggered or uncomfortable hearing a man's voice.

   “I think that maybe you should have an option to choose a male or a female [responder], because a lot of us females are dealing with military sexual trauma and we feel more comfortable speaking to a female… “

   “… my crises are usually male-centered or because of male issues, so it’s hard for me to access if I don’t have an option to talk to a female.”

   Some participants noted that they had requested to speak to a woman responder or had hung up when calling the VCL and hearing a man’s voice. They also recommended VCL offer callers an option of responder gender.

   “I got hurt in the military by men, and so I don’t want to talk to a man about my feelings… So I sometimes say, is it possible I could speak to a female?”

   “If there was a choice, would you rather talk to a man, or would rather talk to a woman that [is] something that I would hope maybe would be available in the future.”

2. Participants also spoke of concerns regarding unwanted intervention, such as having emergency rescue arrive at their home as a result of the VCL call. Although all who participated in the interviews had called VCL, in some cases Veterans spoke of reluctance about calling VCL because of these concerns and noted that it would be helpful to have a greater understanding of what to expect when calling VCL.

   “I was concerned that somebody was gonna come to my house… against my will, like an involuntary intervention.”

   “I didn’t know what to expect… I was afraid if I told them too much information that they would send the cops after me, or mental- or the ambulance or whatever. I was not sure if… this was something that’s going to affect my disabilities or something.”

   These findings suggested that more information should be provided to women Veterans about what to expect when calling VCL.

   
3. Women Veterans who had called VCL noted appreciation of this service as a critical resource, especially as an opportunity to connect with someone when other resources are not available.

“It’s important that Veterans have that resource… they’re available 24-hours-a-day, seven days a week. And I find that it’s useful and it works. It has worked for me every time I’ve called them.”

4. Participants also suggested increased marketing of VCL specifically to women Veterans, noting that some women Veterans might not reach out because they do not know about VCL or do not know the scope of services VCL offers, what to expect when calling VCL, and in what situations VCL can be used (i.e., not limited to acute suicidal crises).

   “So, number one, people don’t know about the crisis line… somebody needs to actually spell it out for some women and say if you just need to tell somebody that something’s wrong… why don’t you call the crisis line and they can do that for you?”

5. Participants also noted a lack of awareness of the full range of VCL services, including being able to reach out to VCL via chat or text options, which may offer more privacy and opportunity in some situations.

   “[I would recommend] more advertisement on the texting and chatting aspect… You can be bawling your eyeballs out and still chatting and you don’t feel embarrassed.”

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Impact and Implications

Interviews with women Veterans who had experience with contacting VCL offered insight into their perspectives and suggestions to inform opportunities for strengthening VCL services specifically for this population. This modality of research - in-depth interviews - allows for identification of important information that is not available through analysis of other data sources. Through the interviews, Veterans are able to share their thoughts and suggestions in ways that are not limited to pre-set or close-ended questions developed by the researchers. Through the interviews, we are able to hear Veterans' voices and thoughts, in their own words, and identify themes that researchers might not have anticipated. Veterans often appreciate the opportunity to share their perspectives and experiences, providing feedback and recommendations through this interview process. By participating in interviews, VA researchers are able to identify factors important to Veterans and to use these findings to inform VA policies and programming.

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