December 2019

In This Issue: Advancements in VA Mental Healthcare
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Advancing Suicide Prevention for Female Veterans

Feature Article

The suicide rate among female Veterans increased 62% between 2000 and 2014 - 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 women. 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. Data on female risk for suicide and womens’ healthcare utilization is needed to direct valuable VHA suicide prevention resources to help address this growing concern.

This ongoing HSR&D study (May 2018 – April 2023) aims to:

• Develop and test explanatory models of female and male risk for repeat suicidal self-directed violence (SSV: fatal and non-fatal suicide attempts) 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.

Initially, study investigators enrolled 25 female and 25 male Veterans for whom a non-fatal SSV event was recorded in a suicide behavior report in VA's Corporate Data Warehouse (CDW). These Veterans were interviewed to gather data on:

• Female and male Veterans’ perspectives and experiences with suicidal thoughts and SSV;
• Female and male Veterans’ recovery needs and experiences with the recovery process, barriers and facilitators to care, and
• How clinicians and the VA healthcare system could better identify and address the needs of Veterans at risk for SSV. 

The initial interviews helped investigators develop a longitudinal survey that is currently being administered to at least 480 female and 480 male Veterans. The survey covers several health and psychosocial topics at baseline, 6- and 12-month follow up, such as coping efficacy, interpersonal conflict, positive relations with others, trauma, occupational problems, barriers to care, and mental health symptoms. Data on SSV events (primary outcome: an SSV event following baseline) occurring during the 12-month follow-up will also be gathered for all participants. Health and utilization data will be obtained from CDW and medical record progress notes. Investigators then will identify differential responses to healthcare use – and how certain health and psychosocial variables cluster together by gender.

Preliminary Findings

• In qualitative interviews, several potential gender differences in risk and resilience were identified. Harms from military culture, institutional betrayal, quality of relationships, self-concept, stressors, and coping strategies were experienced differently among women than men.
• These differences are being explored in ongoing qualitative analysis and will be further examined in the quantitative survey data.

Impact

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 programing 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, is with HSR&D’s Center to Improve Veteran Involvement in Care (CIVIC), in Portland, OR.

Hoffmire C and Denneson L. Concerning trends in suicide among women Veterans point to need for more research on tailored interventions. HSR&D FORUM: Research Highlights. May 1, 2018.

View study abstract