Abstract

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.

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DRA: Mental, Cognitive and Behavioral Disorders

DRE: Prevention, TRL - Applied/Translational

Keywords: Risk Factors, Suicide

MeSH Terms: None at this time.