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IIR 18-287 – HSR Study

IIR 18-287
Strengthening Suicide Prevention Efforts for Women Veterans through the Veterans Crisis Line
Melissa E. Dichter, PhD MSW
Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
Philadelphia, PA
Funding Period: July 2020 - June 2024


Background. The suicide rate among women Veterans has increased substantially in recent years, particularly among younger women and those with limited or no engagement in Veterans Health Administration (VHA) care. The U.S. Department of Veterans Affairs (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 male Veterans. However, research has identified potentially unique characteristics associated with suicide risk among women Veterans and a need for further investigation into how to best meet the suicide prevention needs of this population. Significance/Impact. The objective of this research is to understand and develop recommendations to better address the suicide prevention needs of women Veterans who utilize the Veterans Crisis Line (VCL). Findings from this study will inform recommendations for strengthening crisis intervention services to prevent suicide among women Veterans. Innovation. The proposed multi-method study will focus on the understudied and vulnerable population of women Veterans who contact the VCL. We will analyze the rich yet largely unexamined data collected by the VCL on user and call characteristics, merge VCL data with VHA medical record data for callers who also access VHA services, and conduct in-depth interviews with women Veteran VCL users to obtain more detailed understanding of their experiences and perspectives. Findings will inform efforts to better tailor VCL services to, and increase engagement of, high-risk women Veterans. Specific Aims. The specific aims are to: (1) describe and compare the demographic and VCL contact characteristics (reason for call, call outcome, and VCL risk rating) among female and male Veteran VCL users; (2) examine the relationship between VCL contact characteristics (risk rating, referral, identified needs) and subsequent fatal and non-fatal suicidal self-directed violence (S-SDV), assessing for variation by Veteran gender, among female and male Veteran VCL users who use VHA services; (3) understand women Veterans’ experiences with and recommendations regarding VCL services, including the use of VCL as a resource for both acute and more upstream suicide prevention. Methodology. This mixed-methods study will utilize (a) administrative data from the VCL, VHA, and Suicide Data Repository (SDR); and (b) semi-structured interviews with women Veterans who have utilized the VCL. To address Aim 1, we will conduct statistical analysis of VCL data for prior-year Veteran users with identified gender (approximately 330,000 contacts per year), comparing demographic and VCL contact characteristics (reason for contact, severity rating, and contact resolution/referral) by gender. For Aim 2, we will merge VCL data with VHA 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. For Aim 3, we will conduct semi-structured telephone interviews with a sample (n = 40) of women Veteran VHA patients who have used the VCL, and assess: their reasons for contacting the VCL, expectations of VCL, experience with VCL service and connection with follow-up services, and recommendations for improvements in suicide prevention services. We will integrate our findings with input from a study-specific 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. Implementation/Next Steps. In collaboration with partners and Veteran stakeholders, findings will be used to develop a set of recommendations for clinical enhancement that operations partners can then implement into policy and practice. Future research will examine the impact of these clinical innovations.

External Links for this Project

NIH Reporter

Grant Number: I01HX002983-01A1

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Journal Articles

  1. Krishnamurti LS, Agha A, Denneson LM, Montgomery AE, Chhatre S, Dichter ME. Gender Differences in Connecting Veterans to Care Through the Veterans Crisis Line: A Mixed Methods Evaluation of Referrals to Suicide Prevention Coordinators. Medical care. 2023 Jan 1; 61(1):50-53. [view]
  2. Dichter ME, Krishnamurti LS, Chhatre S, Hoffmire CA, Monteith LL, Bellamy SL, Iverson KM, Montgomery AE, Agha A, McCoy I. Gender differences in veterans' use of the Veterans Crisis Line (VCL): Findings from VCL call data. General hospital psychiatry. 2022 Jan 1; 74:65-70. [view]
  3. Krishnamurti LS, Agha A, Iverson KM, Monteith LL, Dichter ME. Outreach to the Veterans Crisis Line During the COVID-19 Pandemic: A Mixed-Methods Analysis. Psychiatric services (Washington, D.C.). 2023 Feb 1; 74(2):142-147. [view]
  4. Monteith LL, Holliday R, Dichter ME, Hoffmire CA. Preventing Suicide Among Women Veterans: Gender-Sensitive, Trauma-Informed Conceptualization. Current Treatment Options in Psychiatry. 2022 Jun 15; 1-16. [view]
  5. Iverson KM, Danitz SB, Shayani DR, Vogt D, Stirman SW, Hamilton AB, Mahoney CT, Gerber MR, Dichter ME. Recovering From Intimate Partner Violence Through Strengths and Empowerment: Findings From a Randomized Clinical Trial. The Journal of clinical psychiatry. 2021 Nov 23; 83(1). [view]
  6. Dichter ME, Chhatre S, Hoffmire C, Bellamy S, Montgomery AE, McCoy I. 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. 2022 Jul 1; 151:561-563. [view]

DRA: Mental, Cognitive and Behavioral Disorders
DRE: Prevention, TRL - Applied/Translational
Keywords: Risk Factors, Suicide
MeSH Terms: None at this time.

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