Advancing Suicide Prevention for Female Veterans

背景：女性退伍军人的自杀率在2000年至2014年期间增加了63%-显着 高于这一时期男性退伍军人中观察到的30%的增长。尽管有大量的 研究风险因素，护理障碍和退伍军人护理利用率的工作，很少有研究研究 这些问题与女性有关。现有的研究受到女性样本量小的限制， 横截面分析和其他方法的局限性。因此，我们对 与自杀相关的健康和心理社会因素、护理障碍以及医疗保健利用模式 女性退伍军人的行为。需要关于女性自杀风险及其医疗保健利用的数据， 指导宝贵的自杀预防资源，帮助VHA解决这个日益严重的问题。 目的：我们研究的目的是告知性别定制的自杀预防方法，使用大型， 最近发生非致命自杀性自我导向暴力（SSV：致命）的女性和男性退伍军人的全国样本 非致命性自杀企图）。我们的目标是：1）开发和测试女性和男性风险的解释模型， 在12个月内重复SSV，2）确定医疗保健利用模式的相似性和差异， 应对策略和症状随时间的变化之间的女性和男性退伍军人在风险的SSV。 方法：这将是第一个混合方法，纵向队列研究的退伍军人与病史的SSV， 是由公共卫生，社会生态框架，以促进检查的范围近端和 SSV的远端风险。首先，我们将确定并招募30名女性和30名男性退伍军人， 事件被记录在VA公司数据仓库（CDW）的自杀行为报告中。这60 退伍军人将参加定性访谈，以收集有关退伍军人的观点和经验的数据， 自杀想法和SSV，他们的康复需求和康复过程的经验，障碍和 护理促进者，以及临床医生和医疗保健系统如何更好地识别和解决 像他们这样的老兵。我们将使用扎根理论的方法来分析成绩单， 女性退伍军人中SSV的风险模型，直接通知调查结构选择，定量 分析计划和定量结果的解释。对于纵向调查，我们将使用自杀 在CDW中的行为报告，以确定和招募至少480名女性和480名男性退伍军人，他们将完成 在基线、6个月和12个月随访时进行健康和心理社会测量。自我报告问卷将 以定性调查结果为依据，包括心理社会和健康相关措施， 效能，人际冲突，与他人的积极关系，创伤，职业问题，护理障碍， 和心理健康症状将对参与者进行为期12个月的随访，以评估和记录所有SSV 事件（主要结局：基线后的SSV事件），将通过多个来源确定。 将从CDW和病历进展记录中获取健康和使用数据。主要数量 分析将使用一个潜在变量建模框架，同时模拟男性和女性在一个多， 组形式来测试女性和男性退伍军人自杀风险的模型。然后，我们将使用潜在类和潜在 过渡分析，以确定对医疗保健利用的不同反应，以及某些健康和 心理社会变量按性别聚集在一起。 意义：本研究的结果将提供以前无法获得的证据，以支持选择 干预目标，并确定高度优先的服务和障碍，以照顾直接规划， 研究重点是有可能感染SSV的女性退伍军人。这项工作也有可能使更广泛的人受益。 有精神健康状况或其他SSV风险因素的女性退伍军人群体。

Background: The suicide rate among female Veterans increased 63% between 2000 and 2014 – significantly higher than the 30% increase observed among male Veterans during this period. Despite a large volume of work examining risk factors, barriers to care, and care utilization among Veterans, little research has examined these issues as they relate to females. Available research has been limited by small female sample sizes, cross-sectional analysis, and other methodological limitations. As such, we know surprisingly little about the health and psychosocial factors, barriers to care, and healthcare utilization patterns associated with suicidal behaviors among female Veterans. Data on female risk for suicide and their healthcare utilization is needed to direct valuable suicide prevention resources and help VHA address this growing and serious problem. Objectives: The goal of our research is to inform gender-tailored suicide prevention approaches, using a large, national sample of female and male Veterans with recent non-fatal suicidal self-directed violence (SSV: fatal and non-fatal suicide attempts). We aim to: 1) Develop and test explanatory models of female and male risk for repeat SSV over 12 months, and 2) Identify similarities and differences in patterns of healthcare utilization, coping strategies, and symptom change over time between female and male Veterans at risk for SSV. Methods: This will be the first mixed-methods, longitudinal cohort study of Veterans with a history of SSV, and is guided by a public health, social-ecological framework to facilitate examination of the range of proximal and distal risks for SSV. First, we will identify and enroll 30 female and 30 male Veterans for whom a non-fatal SSV event was recorded in a suicide behavior report in VA's Corporate Data Warehouse (CDW). These 60 Veterans will participate in qualitative interviews to gather data on Veterans' perspectives and experiences with suicidal thoughts and SSV, their recovery needs and experiences with the recovery process, barriers and facilitators to care, and how clinicians and the healthcare system could better identify and address the needs of Veterans like them. We will use a grounded theory approach to analyze transcripts to develop a theoretical model of risk for SSV among female Veterans, directly informing survey construct selection, quantitative analysis plans, and interpretation of quantitative findings. For the longitudinal survey, we will use suicide behavior reports in CDW to identify and enroll at least 480 female and 480 male Veterans, who will complete health and psychosocial measures at baseline, 6- and 12-month follow up. Self-report questionnaires will be informed by the qualitative findings and include psychosocial and health-related measures such as coping efficacy, interpersonal conflict, positive relations with others, trauma, occupational problems, barriers to care, and mental health symptoms. Participants will be followed for 12 months to assess and document all SSV events (primary outcome: an SSV event following baseline), which will be ascertained via multiple sources. Health and utilization data will be obtained from CDW and medical record progress notes. Main quantitative analyses will use a latent variable modeling framework to simultaneously model males and females in a multi- group format to test models of female and male Veteran suicide risk. We will then use latent class and latent transition analysis to identify differential responses to healthcare utilization and how certain health and psychosocial variables cluster together by gender. Significance: Findings from this study will provide previously unavailable evidence to support the selection of intervention targets as well as identify high-priority services and barriers to care to direct programing and research priorities for female Veterans at risk for SSV. This work has the potential to also benefit the broader population of female Veterans with mental health conditions or other risk factors for SSV.