Abstract

The suicide rate among Women Veterans is more than double that of adult civilian women, and increased by nearly 63% from 2001 to 2014. The Department of Veterans Affairs (VA) has been tasked with identifying acceptable and effective mental health and suicide prevention strategies for women Veterans in order to curb this rising suicide rate. One approach would be to identify optimal care settings, outside of mental health, in which to integrate upstream suicide prevention initiatives tailored to meet the needs of women Veterans. When considering potential settings, it is important to note that particular concern regarding elevated and increasing suicide rates has been observed for younger women Veterans. Many of these women served in the post-9/11 OEF/OIF/OND era and experienced different exposures (i.e., increased combat) than women serving in earlier eras. Younger women of childbearing age (18-44 years) also constitute the fastest growing subgroup of Veterans, and currently comprise over 40% of women Veterans using Veterans Health Administration (VHA) services. For women of childbearing age, reproductive health care (RHC), including contraception- and pregnancy-related care, is one of the most frequent reasons for seeking services; thereby, making RHC settings viable targets for upstream suicide prevention efforts. Importantly, reproductive life events (e.g., pregnancy, infertility, perimenopause) are also associated with increased vulnerability to anxiety, depression and emotional distress, conditions which increase suicide risk in the general population. Among women Veterans using VHA services, reproductive health diagnoses and mental health conditions frequently co-occur. Further, military sexual trauma (MST), which is reported by approximately 27% of women Veterans using VHA services, is a risk factor for suicidal ideation (SI) and suicidal self-directed violence (S-SDV: suicide and non-fatal suicide attempt), and may simultaneously increase risk of specific reproductive health problems and distress surrounding clinical care. Integration of suicide risk assessment and prevention for women Veterans within VA RHC settings may therefore provide a unique avenue for upstream suicide prevention efforts. Towards this end, the objective of this study is to begin the process of determining if there is an unmet opportunity to integrate upstream evidence-based suicide prevention strategies into VA reproductive health care settings, and to identify optimal strategies for doing so. Accordingly, the following aims will be examined among women OEF/OIF/OND Veterans, 18-44 years of age, using health care services provided or paid for by the VA. Primary Aims: (1) Estimate the rate and prevalence of suicide, non-fatal S-SDV, and SI by use of RHC services (overall use and use of specific services [e.g., contraception] or presence of specific diagnoses received [e.g., infertility]; and (2) Describe Veterans’ beliefs, attitudes, and preferences regarding suicide risk assessment and prevention within RHC settings through qualitative interviews. Secondary Aim: (1) Estimate the prevalence of common medical and mental health comorbidities, and exposures and experiences across the lifespan (i.e., pre-military, military, and post-military) likely to increase S-SDV risk among women using RHC services. Exploratory Aim: Estimate the associations between correlates of interest and SI and non-fatal S-SDV in this patient population. Study procedures will be achieved through mixed-methods which will include: (1) a population-level analysis of VA administrative data; (2) an online, cross-sectional survey to a sample of women Veterans using RHC services; and (3) qualitative semi-structured interviews with a sub-sample of survey participants. Findings from this pilot study will support a trajectory of research aiming to guide the successful integration of suicide prevention strategies within VHA RHC settings. The knowledge to be gained from this initial research step is essential prior to designing future studies to assess provider preferences and determine the cost and feasibility of implementing suicide prevention programs in RHC settings

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DRA: Mental, Cognitive and Behavioral Disorders, Health Systems

DRE: Prevention, TRL - Development

Keywords: Reproductive Care (Gynecological), Suicide

MeSH Terms: None at this time.