Rapid Response to Executive Order by HSR&D Investigators Leads to Widespread Adoption of Suicide Prevention Strategies

BACKGROUND:
Currently, the suicide rate for both men and women Veterans is 1.5 times higher than the overall U.S. population. As part of the response to Presidential Executive Order No. 13861, this study analyzed a large body of text responses collected as a federal Request for Information (RFI) to uncover gaps in policy and practice across the U.S. in order to more effectively address and prevent suicide among Veterans. Responses to the RFI were submitted online or by email (July 3 – August 5, 2019) by community members throughout the country who had personal or professional experience with Veteran health and preventing suicide (n = 722: 608 individuals, 114 organizations. A total of 9,040 responses were collected. Given the urgency of the topic, VA required an analysis of the RFI data to be completed within three months. An HSR&D research team was assembled to analyze the data, identify themes, and uncover what is not yet understood about Veteran suicide. The study team received the data in September 2019 as a corpus of text files, and devised a technology-assisted qualitative process to analyze the text data rapidly. The process of large-scale information extraction – coupled with ongoing qualitative coding and expert review – enabled reviewing the large body of qualitative data at a rapid scale, while still capturing the opinions, experiences, and emotions of individual respondents.

FINDINGS:

• Findings identified unique barriers to care, in addition to ways in which data and research could be better aligned to improve outcomes. For example:
  • Veterans need a greater connection to the community when they transition from military service and they want healthcare professionals who understand and/or have experience with military culture.
  • Metrics for evidence-based risk prevention and treatment methods need to incorporate Veterans’ perspectives to ensure suicide prevention efforts address their needs and concerns.

IMPLICATIONS:

• VA used the findings and policy opportunities identified from this RFI analysis to contribute to the development of The PREVENTS Roadmap with recommendations and implementation steps for suicide prevention. Thus far, the governors of 42 states and territories have submitted state proclamations to support the PREVENTS campaign and follow strategies outlined within the report.
• The HSR&D “QUICk: A Qualitative Interdisciplinary Collaboration” method developed for this study has been submitted for VA invention disclosure and could be useful for other researchers to address similar public requests for information or to help analyze other types of qualitative data to fulfill research mandates.

LIMITATIONS:

• Due to the RFI requirements, the time allowed to analyze the large corpus of data was compressed.

AUTHOR/FUNDING INFORMATION:
This study was supported by the Clinical Science Research and Development Service, using HSR&D resources and facilities. Drs. Kalvesmaki, Pugh, and Jones, Mr. Chapman, and Ms. Peterson are with HSR&D’s Informatics, Decision-Enhancement and Analysis Sciences Center, Salt Lake City.

Kalvesmaki AF, Chapman AB, Peterson KS, Pugh MJ, Jones M, and Gleason TC. Analysis of a National Response to a White House Directive for Ending Veteran Suicide. Health Services Research. March 3, 2022; online ahead of print.