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Publication Briefs

Study Suggests Male and Female Veterans Differ in Attitudes to Referral to VA Care after Calling the Veterans Crisis Line

VA has implemented several programs to address suicide prevention for Veterans, including the Veterans Crisis Line (VCL) – a free service accessible by telephone, text, or chat 24/7. In addition, all VA medical centers are required to staff at least one Suicide Prevention Coordinator (SPC). Some women Veterans report discomfort in VA settings, which tend to be male-dominated and where they may experience gender-based harassment, potentially presenting a challenge to connecting women to an onsite SPC at VA. This study described SPC referral outcomes for Veterans who contacted the VCL with active thoughts of suicide during calendar years 2018–2019. Investigators also examined the reasons Veterans declined referral to further care, and whether the reasons differed by gender, by examining the synopses of notes for 200 calls, which were evenly distributed by caller gender.


  • An analysis of reasons given for declining SPC referral suggests that concerns about or discomfort with VA care were a key concern, particularly among women Veterans:
    • Women had a higher rate of declining SPC referrals than men (6% vs. 5%).
    • Men who expressed negative sentiment toward VA appeared to express anger broadly at VA. In contrast, women who expressed negative experiences or views of VA were more likely than men to express frustrations with VA treatment. Compared with men, women who reported a negative experience with or perception of VA care had concerns regarding potentially losing access to their children, being “locked up,” or even fear of retaliation or judgement from VA staff if they pursued an SPC referral.
  • Veterans who called the VCL and were rated as lower risk were more likely to decline referral to future care. This suggests that the VCL interaction itself may have been sufficient in managing the Veteran’s needs at the time – and it helped mitigate an immediate mental health crisis.


  • The VCL may provide an important opportunity to further engage vulnerable Veterans into care; however, it is important to address perceptions of and experiences with VA care, especially for women Veterans, as well as to consider expansion of telehealth options for follow-up care.


  • Study data do not indicate whether Veterans who accepted the referral for future care actually engaged with or responded to the SPC’s outreach attempts.
  • Due to lack of full availability in the VCL database, this analysis does not include demographics or other socioeconomic factors that may influence a referral outcome.

This study was funded by HSR&D (IIR 18-287). Drs. Krishnamurti, Agha, and Dichter are part of HSR&D’s Center for Health Equity Research and Promotion (CHERP); Dr. Denneson is part of HSR&D’s Center to Improve Veteran Involvement in Care (CIVIC), and Dr. Montgomery is part of the Birmingham VA Health Care System.

Krishnamurti L, Agha A, Denneson L, Montgomery A, Chhatre S, and Dichter M. Gender Differences in Connecting Veterans to Care through the Veterans Crisis Line: A Mixed-methods Evaluation of Referrals to Suicide Prevention Coordinators. Medical Care. January 1, 2023;61(1):50-53.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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