Abstract

Background: The first four years after military service separation, while Veterans are reintegrating into civilian life, is the highest risk period for suicide among Veterans. Veterans also face a number of reintegration challenges resuming civilian life roles. Importantly, women and men Veterans may experience this period differently. This study will provide valuable data on the reintegration experiences of Veterans at risk for suicide across six key domains of Veteran reintegration, identify reintegration experiences associated with increased suicide risk, and elucidate gender differences in reintegration experiences and associated suicide risk. Significance: This study will increase our understanding of suicide risk during Veteran reintegration and will support development of prevention efforts tailored for women Veterans during this period. These data are needed to inform recent executive orders and VA initiatives calling for increased suicide prevention efforts among reintegrating Veterans; findings from this study will identify subgroups of reintegrating Veterans most in need of valuable resources and which reintegration challenges are especially problematic and when – enabling VA to develop selective prevention approaches within this important population. Innovation & Impact: This study moves the field beyond cross-sectional studies of suicide risk among Veterans of recent eras and is carefully designed to study gender differences in suicide risk, building on the body of research and theory in suicide prevention and emerging findings of gender differences in suicide risk. Furthermore, this study is innovative in its linking of VA-DoD datasets to identify a national sample of newly separated Veterans at increased risk of suicide who are not necessarily engaged in VA healthcare. Specific aims: The specific aims of this study are to: 1) Model the trajectories of reintegration challenges of at- risk Veterans to identify population subgroups (e.g., stable, deteriorating, improving) and examine gender differences in reintegration experiences, 2) Identify associations between trajectories identified in Aim 1 and suicide-risk-related predisposing factors among women and men, and 3) Identify associations between trajectories identified in Aim 1 and development, or worsening, of suicide risk (suicidal ideation, suicide cognitions, suicide attempts) and any effect measure modification by gender. Methodology: This is a national cohort survey study. We will enroll a cohort of 2,000 Veterans separating from service in the prior six months, identified using the VA-DoD Veteran Identity Repository (VADIR) data. We will oversample for women to enroll a cohort that is approximately half women. We will also oversample for risk indicators available in Department of Defense (DoD) healthcare data available through DaVINCI (i.e., prior mental health inpatient/outpatient visit, emergency department visit, other outpatient visit). After completing the baseline survey, participants will complete 6 additional surveys over the course of a 36 month follow up period. Surveys will include measures that assess functioning in the six core domains of reintegration challenges (mental and physical heath, identity/role negotiation, relationship quality, financial well-being, spirituality) as well as predisposing factors associated with increased risk for suicide and measures assessing suicide risk (suicidal ideation, suicide cognitions, suicide attempts). Main analyses will identify the reintegration trajectories, including any gender differences, examine the suicide-related predisposing factors associated with deteriorating trajectories, and examine suicide risk outcomes associated with reintegration trajectories. Next steps: Data gathered in this study will directly inform the many VA initiatives, legislation, and recent executive orders calling for increased suicide prevention efforts among reintegrating Veterans by providing the necessary data to identify subgroups of Veterans at increased risk of suicide and their respective needs – directing valuable resources. The VA Office of Mental Health and Suicide Prevention and the VA Office of Social work are strong partners in these efforts and will support dissemination and implementation of findings.

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DRA: Mental, Cognitive and Behavioral Disorders

DRE: TRL - Applied/Translational

Keywords: Reintegration Post-Deployment, Suicide

MeSH Terms: None at this time.