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Hoffmire CA, Kittel JA, Brenner LA, Schneider AL, Katon J, Miller C, Monteith LL. Suicidal Ideation and Suicide Attempts Among Women Veterans Using VA Reproductive Health Care: Prevalence and Associations With Fertility-, Pregnancy- and Parenting-related Factors. Womens Health Issues 2024:S1049-3867(24)00060-4. [PMID: 39107152 DOI: 10.1016/j.whi.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 06/21/2024] [Accepted: 06/26/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION Women veterans are at increased risk for suicide and experience a high prevalence of suicidal ideation (SI) and suicide attempt (SA) history. Knowledge regarding SI/SA correlates among women veterans who use reproductive health care services is limited, inhibiting development of evidence-based, gender-sensitive suicide prevention programming tailored to meet women veterans' needs and preferences. This study aimed to 1) describe the prevalence and characteristics of SI and SA among women veterans using Veterans Health Administration (VHA) reproductive health care services and 2) provide an initial exploration of associations between fertility-, pregnancy-, and parenting-related factors with SI and SA to guide future research. METHODS Post-9/11 women veterans (n = 352) who used VHA reproductive health care in fiscal year 2018 completed a cross-sectional survey on reproductive health, mental health, and parenting. RESULTS Approximately 30% and 12% experienced SI and SA(s), respectively, after military service; 10% reported past-month SI. Infertility, pregnancy loss, age at first pregnancy, and parental status were not significantly associated with SI or SA history, although notable effect sizes were observed for infertility and age at first pregnancy; further research is warranted. Among parents, parental functioning was not associated with SI/SA, but lower parental satisfaction was significantly associated with past-month SI (prevalence ratio, 3.36; 95% confidence interval, 1.19-9.46; adjusting for demographics, military characteristics, mental health symptoms). CONCLUSIONS Postmilitary SI and SA(s) are common among women veterans accessing VHA reproductive health care services. Those with low parental satisfaction may be at particularly high risk. Findings can guide future research and inform clinical care to facilitate suicide prevention.
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Affiliation(s)
- Claire A Hoffmire
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Julie A Kittel
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lisa A Brenner
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Alexandra L Schneider
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
| | - Jodie Katon
- Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Christin Miller
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
| | - Lindsey L Monteith
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Dichter ME, Agha AZ, Monteith LL, Krishnamurti LS, Iverson KM, Montgomery AE. "Something Has to Be Done to Make Women Feel Safe": Women Veterans' Recommendations for Strengthening the Veterans Crisis Line for Women Veterans. Womens Health Issues 2024; 34:180-185. [PMID: 38199835 DOI: 10.1016/j.whi.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Women represent 15% of veteran callers to the Veterans Crisis Line (VCL); there has been little research identifying the experiences and needs of women veterans who use the VCL. The objective of this study was to identify women veterans' experiences with and recommendations for strengthening VCL services for women. METHOD We conducted qualitative interviews with 26 women veterans across the United States who had contacted the VCL in the preceding year. Interviews were conducted by telephone in 2022 and were audio recorded and transcribed. A team-based content analysis approach was used to identify participants' concerns around contacting the VCL and recommendations for strengthening the service. RESULTS Interviews revealed women veterans' concerns with regard to contacting the VCL related to responder gender, appropriateness of VCL services for veterans not at imminent risk for suicide, and potential consequences of contacting the VCL. Key recommendations included letting veterans select the gender of the responder who takes their call, providing more information to potential callers about what to expect from VCL calls, and raising awareness about and maintaining options for caller anonymity. CONCLUSIONS This study uniquely focused on women veterans' experiences and perspectives, in their own voices. Findings point to trauma-informed approaches supporting women veteran callers to the VCL and may also hold implications for other similar crisis hotline services.
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Affiliation(s)
- Melissa E Dichter
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania; College of Public Health, Temple University School of Social Work, Philadelphia, Pennsylvania.
| | - Aneeza Z Agha
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania
| | - Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, U.S. Department of Veterans Affairs, Denver, Colorado; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Denver, Colorado
| | - Lauren S Krishnamurti
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Veteran Suicide Prevention, U.S. Department of Veterans Affairs, Denver, Colorado
| | - Katherine M Iverson
- National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, U.S. Department of Veterans Affairs, Boston, Massachusetts; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Ann Elizabeth Montgomery
- Birmingham VA Health Care System, U.S. Department of Veterans Affairs, Birmingham, Alabama; School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
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Krishnamurti LS, Denneson LM, Agha A, Beyer N, Mitchell S, Dichter ME. Improving suicide prevention for women veterans: Recommendations from VHA suicide prevention coordinators. Gen Hosp Psychiatry 2023; 84:67-72. [PMID: 37393650 DOI: 10.1016/j.genhosppsych.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Women are a minority veteran subpopulation experiencing particular risk for suicide and facing distinct challenges in accessing Veterans Health Administration (VHA) care. As part of efforts to enhance suicide prevention, the VHA established Suicide Prevention Coordinators (SPC) as clinicians who work exclusively to connect high-risk veterans to the scope of VHA's services. To understand the experiences of women veterans with suicide risk who access care, this study presents findings from qualitative interviews with SPCs regarding the care needs, preferences, and concerns of women veterans who utilize VHA for enhanced suicide-related care. METHODS We conducted qualitative interviews with 20 SPCs from 13 VAMCs around the United States. We specifically asked SPCs to share perspectives on women veterans' barriers to accessing care and their recommendations to improve suicide prevention for this subpopulation. We conducted a thematic content analysis to extract key themes. RESULTS SPCs revealed that women veterans opt to avoid VHA due to prior negative experiences, often related to provider sensitivity to women's issues. Safety was another key concern, specifically related to feeling unwelcome or intimidated in the male dominated veteran community. Key provider recommendations include increasing the availability of gender-sensitive providers and making changes to the physical spaces of the VHA to better facilitate women veterans' access to care. CONCLUSIONS SPCs underscored the importance of comfort and relatability between women patients and providers, especially in relation to enhanced care for suicide risk. This study presents important evidence in support of enhancing suicide prevention by better engaging women veterans in care that is more inclusive and more sensitive to their experiences and identity, in and outside VHA.
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Affiliation(s)
- Lauren S Krishnamurti
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America.
| | - Lauren M Denneson
- U.S. Department of Veterans Affairs, VA Portland Health Care System, Portland, OR, United States of America; Oregon Health and Science University School of Medicine, Portland, OR, United States of America
| | - Aneeza Agha
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA, United States of America
| | - Nicole Beyer
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
| | - Shannon Mitchell
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
| | - Melissa E Dichter
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA, United States of America; Temple University School of Social Work, Philadelphia, PA, United States of America
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Monteith LL, Kittel JA, Schneider AL, Miller CN, Holliday R, Katon JG, Brenner LA, Hoffmire CA. Military Sexual Trauma Among Women Veterans Using Veterans Health Administration Reproductive Health Care: Screening Challenges and Associations with Post-Military Suicidal Ideation and Suicide Attempts. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:7578-7601. [PMID: 36695157 PMCID: PMC10175204 DOI: 10.1177/08862605221145725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Military sexual trauma (MST) is highly prevalent among women veterans. Research among MST survivors has focused on individuals receiving care in specific settings, such as mental health services. There is a dearth of knowledge regarding MST prevalence and associations in other settings commonly accessed by women veterans, including reproductive healthcare settings. We examined MST prevalence (overall, by MST type and extent of underreporting) and associations with suicidal ideation and suicide attempts, among women veterans accessing Veterans Health Administration (VHA) reproductive health care. Our sample included 352 post-9/11 women veterans who used VHA reproductive health care in Fiscal Year (FY) 2018 and participated in a cross-sectional survey. Approximately 68.7% screened positive for MST, including 44.9% who reported experiencing military sexual assault. Notably, 30.8% reported MST on the survey, but had a negative MST screen for their most recent MST screen in their VHA medical record. Both military sexual harassment and assault were associated with increased prevalence of experiencing suicidal ideation following military service; however, a significant association among military sexual harassment, past-month suicidal ideation, and post-military suicide attempts was not detected. Military sexual assault was uniquely associated with past-month suicidal ideation and post-military suicide attempts. As MST and underreporting are highly prevalent among women veterans using VHA reproductive health care, rescreening for MST within this population is essential. A trauma-informed approach is recommended irrespective of prior MST screening results and may facilitate suicide prevention in this population. Addressing barriers to MST disclosure and preventing MST and its sequelae remain critical.
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Affiliation(s)
- Lindsey L. Monteith
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Julie A. Kittel
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, CO, USA
| | - Alexandra L. Schneider
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, CO, USA
| | - Christin N. Miller
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, CO, USA
| | - Ryan Holliday
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Lisa A. Brenner
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Claire A. Hoffmire
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Monteith LL, Holliday R, Miller CN, Schneider AL, Brenner LA, Hoffmire CA. Prevalence and Correlates of Firearm Access Among Post-9/11 US Women Veterans Using Reproductive Healthcare: a Cross-Sectional Survey. J Gen Intern Med 2022; 37:714-723. [PMID: 36042091 PMCID: PMC9481791 DOI: 10.1007/s11606-022-07587-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Suicide rates have increased among women Veterans, with increased use of firearms as the method. Addressing suicide risk in this population requires understanding the prevalence and correlates of firearm access in healthcare settings frequented by women Veterans. OBJECTIVES Characterize the prevalence and correlates of firearm ownership and storage practices among women Veterans using Department of Veterans Affairs (VA) reproductive healthcare (RHC) services. DESIGN Cross-sectional national survey conducted in 2018-2019 (17.9% response rate). PARTICIPANTS Post-9/11 women Veterans using RHC (n=350). MAIN MEASURES VA Military Sexual Trauma Screen, PTSD Checklist for DSM-5, Hurt/Insult/Threaten/Scream, Columbia-Suicide Severity Rating Scale screener, self-reported firearm access. KEY RESULTS 38.0% (95% confidence interval [95% CI]: 32.9, 43.3) of participants reported personally owning firearms, and 38.9% (95% CI: 33.7, 44.2) reported other household members owned firearms. Among those with firearms in or around their homes, 17.8% (95% CI: 12.3, 24.4) and 21.9% (95% CI: 15.9, 28.9) reported all were unsafely stored (loaded or unlocked, respectively). Women who experienced recent intimate partner violence were less likely to report personally owning firearms (adjusted prevalence ratio [APR]=0.75; 95% CI: 0.57, 0.996). Those who experienced military sexual harassment (APR=1.46; 95% CI=1.09, 1.96), were married (APR=1.74; 95% CI: 1.33, 2.27), or lived with other adult(s) (APR=6.26; 95% CI: 2.87, 13.63) were more likely to report having household firearms owned by someone else. Storing firearms loaded was more prevalent among women with lifetime (APR=1.47; 95% CI=1.03, 2.08) or past-month (APR=1.69; 95% CI=1.15, 2.48) suicidal ideation and less likely among those with other adult(s) in the home (unadjusted PR=0.62; 95% CI=0.43, 0.91). Those with parenting responsibilities (APR=0.61; 95% CI=0.38, 0.97) were less likely to store firearms unlocked. CONCLUSIONS Firearm access is prevalent among post-9/11 women Veterans using VA RHC. Interpersonal factors may be important determinants of firearm access in this population. Safe firearm storage initiatives are needed among women Veterans using RHC, particularly for those with suicidal ideation.
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Affiliation(s)
- Lindsey L Monteith
- VA Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Aurora, CO, 80045, USA. .,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Ryan Holliday
- VA Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Aurora, CO, 80045, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christin N Miller
- VA Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Aurora, CO, 80045, USA
| | - Alexandra L Schneider
- VA Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Aurora, CO, 80045, USA
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Aurora, CO, 80045, USA.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Claire A Hoffmire
- VA Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Aurora, CO, 80045, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Monteith LL, Holliday R, Dichter ME, Hoffmire CA. Preventing Suicide Among Women Veterans: Gender-Sensitive, Trauma-Informed Conceptualization. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2022; 9:186-201. [PMID: 35730002 PMCID: PMC9198614 DOI: 10.1007/s40501-022-00266-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review There is growing concern regarding suicide among women veterans, who have experienced an increase in suicide rates that has exceeded that reported for other US adult populations. Recent research has bolstered understanding of correlates of suicide risk specific to women veterans. Yet most existing suicide prevention initiatives take a gender-neutral, rather than gender-sensitive, approach. We offer clinical considerations and suggestions for suicide prevention tailored to the needs, preferences, and experiences of women veterans. Discussion is framed around the White House strategy for preventing suicide among military service members and veterans. Recent Findings Considering high rates of trauma exposure among women veterans, we propose that a trauma-informed lens is essential for taking a gender-sensitive approach to suicide prevention with this population. Nonetheless, research to inform evidence-based assessment and intervention remains largely focused on veteran men or gender-neutral. Integral next steps for research are posited. Summary Extant research provides an initial foundation for beginning to understand and address suicide among women veterans in a gender-sensitive, trauma-informed manner. Additional research that is specific to women veterans or that examines gender differences is critical to ensure women veterans receive optimal, evidence-based care to prevent suicide.
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Firearm Lethal Means Counseling Among Women: Clinical and Research Considerations and a Call to Action. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2022; 9:301-311. [PMID: 35791313 PMCID: PMC9247955 DOI: 10.1007/s40501-022-00273-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Abstract
Purpose of review Firearm injury is the leading mechanism of suicide among US women, and lethal means counseling (LMC) is an evidence-based suicide prevention intervention. We describe current knowledge and research gaps in tailoring LMC to meet the needs of US women. Recent findings Available LMC and firearm suicide prevention literature has not fully considered how LMC interventions should be tailored for women. This is especially important as firearm ownership and firearm-related suicides among women are increasing. Additional research is needed to better understand firearm characteristics, behaviors, and beliefs of US women, particularly related to perceptions of personal safety and history of trauma. Research is also needed to identify optimal components of LMC interventions (e.g., messengers, messages, settings) and how best to facilitate safety practices among women with firearm access who are not themselves firearm owners but who reside in households with firearms. Finally, it will be important to examine contextual and individual factors (e.g., rurality, veteran status, intimate partner violence) which may impact LMC preferences and recommendations. Summary This commentary offers considerations for applying existing knowledge in LMC and firearm suicide prevention to clinical practice and research among US women, among whom the burden of firearm suicide is increasing.
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