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Health Services Research & Development

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HSR&D In Progress

September 2022

In This Issue: Women's Health Research

»Table of Contents

Strengthening Suicide Prevention Efforts for Women Veterans through the Veterans Crisis Line

Feature Article


Takeaway: The suicide rate among women Veterans has increased substantially in recent years, particularly among younger women and those with limited or no engagement in VA healthcare. Findings from this study will inform recommendations for strengthening crisis intervention services to prevent suicide among women Veterans.


The suicide rate among women Veterans has increased substantially in recent years, particularly among younger women and those with limited or no engagement in VA healthcare. VA has invested extensive resources toward preventing suicide among Veterans, including through the Veterans Crisis Line (VCL). Prior research on Veteran suicide prevention and VCL use has focused largely on men Veterans. However, research has identified potentially unique characteristics associated with suicide risk in women Veterans and a need for further investigation into how to best meet the suicide prevention needs of this population.

This ongoing study (July 2020–June 2023) seeks to understand and develop recommendations to better address the suicide prevention needs of women Veterans who use the VCL. Investigators aim to:

  • Describe and compare the demographic and VCL contact characteristics (reason for call, call outcome, and VCL risk rating) among women and men Veteran VCL users.
  • Examine the relationship between VCL contact characteristics (risk rating, referral, identified needs) and subsequent fatal and nonfatal suicidal self-directed violence, and assess variation in women and men Veteran VCL users who use VA services.
  • Understand women Veterans’ experiences with and recommendations regarding VCL services, including the use of VCL as a resource for both acute and upstream suicide prevention.

Methods

This study uses administrative data from the VCL, VA medical records, and the Suicide Data Repository (SDR) as well as semi-structured interviews with women Veterans who have used the VCL. Researchers analyzed VCL call record data, comparing demographic and VCL contact characteristics (reason for contact, severity rating, and contact resolution/referral) by gender.

In addition, researchers merged VCL data with VA health records and SDR data to assess relationships between VCL risk rating and suicidal ideation, suicide attempts, and suicide, with consideration of other health and service utilization characteristics. Through semi-structured telephone interviews with a sample of women VA patients who have used the VCL, researchers will assess the women’s reasons for contacting the VCL, their expectations of VCL, their experience with VCL service and connection with follow-up services, and their recommendations for improvements in suicide prevention services.

Researchers will integrate their findings with input from a stakeholder advisory board composed of Veterans and clinical and operations partners to develop recommendations for enhancing VA’s crisis intervention and broader suicide prevention efforts for women Veterans.

Findings

  • From 2018 to 2019, the distribution of the timing of calls (time of day, day of the week, season of the year), and demographic and VCL contact characteristics (reason for call, call outcome, and VCL risk rating) were similar among female (n=116,029) and male (n=651,239) VCL users, with women slightly more likely than men to call during the evening and on weekends.
  • Mental health was the most common reason for calls, and more likely among calls by women (62%) than men (51%).
  • Gender differences in the reason for the call were largely related to interpersonal relationship challenges and violence (military sexual trauma, non-military sexual violence, and abuse), with more prominence among calls by women.
  • Women were more likely than men to report suicide risk, including suicide ideation and prior suicide attempt.

Anticipated Impact

Findings will inform recommendations for strengthening crisis intervention services to prevent suicide among women Veterans, and inform efforts to better tailor VCL services to, and increase engagement of, high-risk women Veterans.

Melissa E. Dichter, PhD, MSWPrincipal Investigator: Melissa E. Dichter, PhD, MSW, is a core investigator with HSR&D’s Center for Health Equity Research and Promotion (CHERP) in Philadelphia and Pittsburgh, PA.


Publications

Dichter M, Krishnamurti L, Chhatre S, et al. Gender differences in veterans' use of the Veterans Crisis Line (VCL): Findings from VCL call data. General Hospital Psychiatry. January 1, 2022;74:65–70.

Dichter M, Chhatre S, Hoffmire C, et al. Variation in call volume to the Veterans Crisis Line by women and men veterans prior to and following onset of the COVID-19 pandemic. Journal of Psychiatric Research. May 23, 2022;151:561–563.

View study abstract

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