Abstract

Despite widespread concern and attention over the past decade, the continuing high rate of suicide among U.S. service members and Veterans (SM/V) remains a pressing public health issue. SM/V rates of suicide by firearm is upwards of 84% in states with high gun ownership rates and a highly rural populace. Limiting firearm access for SM/V at high risk for suicide would decrease suicide deaths; however, interventions such as safety messaging and other prevention efforts implemented in Department of Defense (DoD) and Veterans Affairs (VA) settings have not led to decreased firearm suicides. Effectiveness of these interventions has been limited by socio-culturally informed views and attitudes common among some SM/V, while delivery of interventions in VA settings has been problematic given that most SM/V who commit suicide are not actively receiving VA services near time of death. Service members who are transitioning out of military service (i.e. from 6 months prior to separation to 18 months post-separation) are vulnerable to suicide by firearm, but many are not well-connected to support services. Our project will engage SM/V peers, military families, firearm owners, and other community opinion leaders in building a VA-community coalition to bring firearms safety messaging and interventions directly to SM/V and their families. Phase I goals of our project include: 1. identifying Veteran ‘champions’ who will co-lead engagement of key military, VA, and community partners; 2. holding meetings with key VA, DoD, and community stakeholders to gather information about varying perspectives on SM/V suicide by firearm, to understand perceived challenges implementing interventions and delivering available resources to support interventions, and to enlist them in joining a community coalition to promote firearm safety; 3. convening a series of 6 deliberative discussion forums with our key stakeholders to identify and agree upon common goals, strategies, and messaging to promote firearm safety and prevent SM/V suicide by firearm, and to select specific interventions and sites for implementation of an intervention; and 4. developing an implementation toolkit and the relationships necessary to support successful implementation of the intervention in Phase II, including tailoring to different settings (e.g., rural and urban, military and community-based). The long-term goal for Phase II is to implement and evaluate the impact of our VA-community developed intervention, which we anticipate will include adaptations of existing strategies that promote safe firearm storage, as well as new messaging and delivery strategies developed in response to barriers and resources identified through our deliberative discussion forums. Given deliberative discussion groups have not been held, we can only offer a preliminary and speculative vision of the Phase II protocol. However, our discussions with individual coalition partners suggest that our Phase II protocol will involve one or more of the following themes: (1) barriers in current messaging, (2) barriers regarding current messenger (e.g., VA health providers versus firearm or veteran advocates) and (3) barriers regarding SM/V preferences on safe storage methods that are currently offered (e.g., preference for devices that allow storage of loaded weapons). The purpose of the deliberative discussion groups is to allow for developing possible consensus regarding how to address perceived barriers and will thus inform Phase II aims and methods. Innovation: This project is innovative in taking a public health approach to change the conversation and the culture around firearm safety messaging by collaborating with a range of community partners—including firearm owners, firearm sellers, firearm rights and firearm safety advocates, mental health providers, and individual Veterans, service members, and military families—to deliver firearm safety counseling and safe storage materials (e.g. trigger locks, gun cabinets) in community-based settings such as gun stores, gun shows, shooting ranges, and events attended by SM/V during the period of transition from military service to civilian life. An additional innovation involves the inclusion of key stakeholders—including Veterans, service members, and military caregivers—as partners in all phases of this work, including Advisory Board and Veteran “champions” as members of the project team. Finally, our use of deliberative discussion forums is an innovative means to identify and address potential barriers to implementing interventions in a range of urban and rural settings, to define common goals and acceptable messaging, and to build capacity for a community-VA partnership to support future implementation and evaluation of an intervention.

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DRA: Mental, Cognitive and Behavioral Disorders

DRE: TRL - Applied/Translational

Keywords: Suicide

MeSH Terms: None at this time.