BACKGROUND/RATIONALE:
Of the approximately 22 completed Veteran suicides each day, only about five are completed by Veterans enrolled in the Veterans Healthcare System. More than 1,250 Veterans who receive care at Veterans Health Administration (VHA) facilities attempt suicide each month; with 15% who survive these attempts making a repeat attempt within the next 12 months. Veterans are more likely to use firearms as a method for suicide accounting for 67% of all Veteran suicides compared to 51% by the general population. However, factors that place a person at risk for, or protect a person from, suicide are not well understood. Few studies have involved survivors of an acute attempt or serious ideation with firearms. Evaluating the context of the suicide attempt and the process for obtaining access to the firearm (including how recent the acquisition, location within the home, and use of safety devices such as gun safety locks) allows for the identification and development of recommendations for reducing access to firearms during periods of extreme emotional distress. Understanding precipitating and preventive factors may help identify common trigger points as well as common areas of resilience which can ultimately inform and guide preventative approaches for Veterans who are at high suicide risk.

OBJECTIVE(S):
This project sought to: 1) Evaluate the context and characteristics of non-fatal suicide events involving firearms; 2) Identify facilitators and barriers to help-seeking and disclosure of intent prior to the event; and 3) Develop recommendations for reducing access to firearms during periods of extreme emotional distress.

METHODS:
Using a mixed methods study design, we recruited Veterans admitted to a VA hospital within 72 hours of a serious suicidal ideation or attempt involving firearms in an effort to understand the characteristic factors involved in the attempt and the context in which it occurred. Fifteen Veterans were enrolled into the study over a 12 month period. Researchers administered a semi-structured qualitative interview followed by a structured self-report survey to all Veteran participants. Qualitative interviews examined the characteristics of each participant and context of their suicide attempts or ideations with firearms. Characteristics of the Veteran included their attitudes about firearms, cultural beliefs in firearm ownership, perceived connectedness to their family and environment, and their attitudes about help seeking. Contextual factors examined included the Veteran's access to and usage patterns with firearms, significant events, environment, relationships, and their description of the suicide event. Researchers used a systematic iterative process that builds upon qualitative methodology and content analysis to code and analyze the transcribed audio files and notes for factors influencing the recent suicide attempt. Following the qualitative interview, Veteran participants completed a structured "Common Data Elements" (CDE) questionnaire that broadly covered essential components of suicidality such as recent suicidal thoughts, relevant cognitive and emotional variables, anxiety and symptoms of post-traumatic stress disorder, insomnia, history of traumatic brain injury, and alcohol/ substance use. Questions regarding demographics, military, and medical history were also included.

FINDINGS/RESULTS:
All participants were male with a mean age of 42 ( 14 yrs). Sixty percent were divorced or separated, 27% lived alone, and 67% were unemployed. Eleven served in the OIF/OEF/OND conflicts; one in Desert Storm, and 3 were Vietnam Era Veterans. Most had served in the Army (60%) or Marines (27%), 93% served in the enlisted ranks, and 87% were exposed to direct combat. Eleven (73%) indicated previous hospitalizations for mental health problems with six (40%) indicating hospitalizations within the last 12 months.

In qualitative interviews, Veterans identified several recent negative life events (e.g. unemployment, relationship problems, PTSD, substance use disorder) as factors facilitating suicide attempts/ideations. All participants indicated current or past negative life events that played a role in facilitating the attempt or ideation. They most often stated that the use of a firearm was due to their familiarity with and known lethality associated with their use. However, many stated that other means had been previously used and would be considered if firearms were not available. Veterans reported the importance of having family and/or friends as a support structure and all acknowledged the importance of seeking help and talking about their physical and mental health problems. The majority (80%) had participated in counseling sessions at some point in their lifetime with 47% reporting participation within the year. However, most indicated that they had not talked to anyone about suicide. Participants reported that participating in the study interviews helped them feel less distressed.

Quantitative data indicated that most (67%) of the Veteran participants had attempted suicide and really hoped to die; 73% had recurring thoughts of killing themselves in the past year, and 40% indicated serious thoughts of killing themselves 5 or more times within the past year. Many Veterans (47%) indicated a likelihood of future reattempts, with 27% indicating that it was "likely," 7% "rather likely," and 13% "very likely." Overall, a majority (60%) of the Veterans felt like they did not belong, that they were not close to other people, and that they did not have many supportive friends. However, 67% felt that other people cared about them and 54% felt that there were people that they could turn to in times of need. Over 60% reported that past stressful military experiences had a continued effect on them and that they avoided situations or thoughts that reminded them of those experiences.

IMPACT:
Results from this study indicate that Veteran suicide attempts/ideations exist over a period of time, Veterans will opt for any means to complete a suicide, choose firearms because of their high lethality rate, and that suicide re-attempts are likely. While a sense of alienation was mentioned by the majority, social support had a preventive function during times of crisis.

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External Links for this Project

NIH Reporter

Grant Number: I21HX001373-01A1
Link: https://reporter.nih.gov/project-details/8678420

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PUBLICATIONS:

Journal Articles

1. Waliski A, Townsend J, Castro MI, Doan R, Kirchner JE, Owen RR, Connor KR. Navigating the institutional review board system to conduct suicide research. Annals of public health and research. 2015 Nov 27; 2(4):1028. [view]

Conference Presentations

1. Waliski A. Characteristics of Non-Fatal Suicide Attempts or Ideations Involving a Firearm as a Method of Choice in Veterans. Poster session presented at: American Counseling Association Annual Conference; 2016 Mar 31; Montreal, Canada. [view]

DRA: Mental, Cognitive and Behavioral Disorders
DRE: Epidemiology
Keywords: none
MeSH Terms: none