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2023 HSR&D/QUERI National Conference Abstract

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4024 — A National Examination of Prevalence, Correlates, and Lived Experience of Suicidal Ideation during the COVID-19 Pandemic among U.S. Veterans

Lead/Presenter: Alexandra Schneider,  Rocky Mountain MIRECC for Suicide Prevention
All Authors: Schneider AL (Rocky Mountain MIRECC for Suicide Prevention), Hoffmire, CA (Rocky Mountain MIRECC for Suicide Prevention; University of Colorado Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation) Holliday, R (Rocky Mountain MIRECC for Suicide Prevention; University of Colorado Anschutz Medical Campus, Department of Psychiatry) Barnes, SM (Rocky Mountain MIRECC for Suicide Prevention; University of Colorado Anschutz Medical Campus, Department of Psychiatry) Gaeddert, LA (Rocky Mountain MIRECC for Suicide Prevention) Brenner, LA (Rocky Mountain MIRECC for Suicide Prevention; University of Colorado Anschutz Medical Campus, Department of Psychiatry; University of Colorado Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation; University of Colorado Anschutz Medical Campus, Department of Neurology) Monteith, LL (Rocky Mountain MIRECC for Suicide Prevention; University of Colorado Anschutz Medical Campus, Department of Psychiatry)

Objectives:
There has been concern regarding the potential for rates of suicidal ideation (SI) and suicidal behaviors to increase during the COVID-19 pandemic. Yet knowledge of Veterans’ SI experiences during this time has remained limited. We examined Veterans’ experiences with SI during the COVID-19 pandemic, including prevalence, characteristics, correlates, and lived experiences regarding the impact of the pandemic.

Methods:
We conducted a survey of 567 Veterans between 12/2020-2/2021. SI was assessed using the Columbia Suicide Severity Rating Scale, adapted to examine SI experiences during the COVID-19 pandemic, as well as within the past year. Participants who experienced SI in the past 12 months were asked to indicate if the frequency and intensity of their suicidal thoughts had changed during the pandemic. We conducted weighted analyses to account for the complex survey design to examine SI prevalence and compare characteristics of the subsamples with and without increased SI frequency during the pandemic. Perceptions of the impact of the COVID-19 pandemic were assessed using an open-ended question and the Perceived Impact of Pandemic Scale-18 (PIPS-18), which was created for this study. Thematic analysis of free text responses was used to explore the lived experiences of Veterans with past-year SI; comparisons were made between those with and without increased SI frequency during the pandemic. Weighted logistic regression models were fit to examine if pandemic-related factors from the PIPS-18 were associated with SI.

Results:
Weighted analyses revealed that 9.6% (95% CI: 6.7, 12.5) of the sample reported experiencing SI in the past year, and 5.0% (95% CI: 2.8, 7.3) reported experiencing SI in the past month. Additionally, 3.1% (95% CI: 1.4, 4.7) reported experiencing increased SI frequency, and 2.2% (95% CI: 0.7, 3.6) increased SI intensity, during the COVID-19 pandemic. Veterans with past-year SI indicated that the pandemic had negatively impacted their mental health, interpersonal interactions and relationships, family, employment, and ability to engage in activities. With the exception of reduced activities, these impacts tended to be more prominent among those with increased SI frequency during the pandemic. The PIPS-18 personal impact scale was associated with past-year SI, past-month SI, and increased SI frequency since the start of the pandemic, accounting for age, race, and the presence of minors in the home. In contrast, the PIPS-18 socioeconomic and interpersonal scales were not associated with SI in adjusted models.

Implications:
While only a small percentage of Veterans reported experiencing increased SI frequency or intensity since the start of the pandemic, perceiving greater personal impacts from the pandemic was associated with a higher likelihood of experiencing SI, as well as increased SI frequency during the pandemic. Additionally, Veterans with increased SI were more likely to describe lived experiences that encompassed a broad range of negative impacts in psychosocial and health domains. Continued efforts to ensure that these Veterans receive evidence-based suicide prevention care is essential.

Impacts:
Increasing our understanding of how Veterans have been impacted by the COVID-19 pandemic can inform how the VA, as well as other healthcare systems, can continue to work towards addressing S-SDV during and following pandemics.