Advancing Suicide Prevention for Female Veterans

推进女性退伍军人自杀预防

• 批准号: 9729452
• 负责人: Lauren M Denneson
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9729452
• 关键词: Address; Attention; Biological; Caring; Conflict (Psychology); Cross-Sectional Studies; Data; Development; Diagnosis; Distal; Distress; Enrollment; Event; Feeling; Feeling suicidal; Female; Gender; Gender Role; Goals; Health; Healthcare; Healthcare Systems; Intervention; Interview; Longitudinal Studies; Longitudinal Surveys; Longitudinal cohort study; Measures; Mediating; Medical Records; Mental Depression; Mental Health; Methodology; Methods; Military Personnel; Modeling; Occupational; Participant; Patient Self-Report; Pattern; Population; Prevention approach; Process; Psychosocial Factor; Public Health; Questionnaires; Recording of previous events; Recovery; Reporting; Research; Research Priority; Resources; Risk; Risk Factors; Sample Size; Sampling; Self-Direction; Services; Socialization; Source; Stress; Substance Use Disorder; Suicide; Suicide attempt; Suicide prevention; Surveys; Symptoms; Testing; Theoretical model; Time; Transcript; Trauma; Veterans; Violence; Work; administrative database; barrier to care; cohort; coping; cost; data warehouse; evidence base; experience; falls; follow-up; gender difference; health care service; health care service utilization; high risk; high risk population; interpersonal conflict; male; primary outcome; programs; psychosocial; response; sexual trauma; social; stressor; suicidal; suicidal behavior; suicidal risk; suicide rate; theories

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.

背景：2000 年至 2014 年间，女性退伍军人的自杀率显着增加了 63% 高于这一时期男性退伍军人中观察到的 30% 的增幅。尽管数量很大 很少有研究调查退伍军人的风险因素、护理障碍和护理利用情况 这些问题与女性有关。现有的研究受到女性样本量较小的限制， 横截面分析和其他方法学局限性。因此，我们对这个问题知之甚少。 健康和心理社会因素、护理障碍以及与自杀相关的医疗保健利用模式 女性退伍军人的行为。需要有关女性自杀风险及其医疗保健利用率的数据 指导宝贵的自杀预防资源并帮助 VHA 解决这一日益严重的问题。 目标：我们研究的目标是通过大量、广泛的研究，为针对性别的自杀预防方法提供信息。 最近发生非致命性自杀性自我暴力的女性和男性退伍军人的全国样本（SSV：致命 和非致命性自杀未遂）。我们的目标是： 1) 开发并测试女性和男性风险的解释模型 在 12 个月内重复 SSV，以及 2) 确定医疗保健利用模式的异同， 面临 SSV 风险的女性和男性退伍军人之间的应对策略以及症状随时间的变化。 方法：这将是第一个针对有 SSV 病史的退伍军人的混合方法纵向队列研究，以及 以公共卫生、社会生态框架为指导，以方便检查近端和 SSV 的远端风险。首先，我们将确定并登记 30 名女性和 30 名男性退伍军人，他们的非致命 SSV 该事件被记录在 VA 企业数据仓库 (CDW) 的自杀行为报告中。这60个 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 自杀念头和 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满足患者的需求 退伍军人喜欢他们。我们将使用扎根理论方法来分析成绩单，以制定理论 女性退伍军人中 SSV 风险模型，直接为调查结构选择提供信息，定量 分析计划以及定量结果的解释。对于纵向调查，我们将使用自杀 CDW 中的行为报告，以确定并招募至少 480 名女性和 480 名男性退伍军人，他们将完成 基线、6 个月和 12 个月随访时的健康和心理社会措施。自我报告问卷将 以定性调查结果为依据，并包括心理社会和健康相关的措施，例如应对措施 功效、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。参与者将被跟踪 12 个月，以评估和记录所有 SSV 事件（主要结果：基线后的 SSV 事件），将通过多个来源确定。 健康和利用数据将从 CDW 和医疗记录进度记录中获得。主要定量 分析将使用潜在变量建模框架来同时对多性别中的男性和女性进行建模 小组形式测试女性和男性退伍军人自杀风险模型。然后我们将使用潜在类别和潜在 转变分析，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来支持选择 干预目标并确定直接规划和护理的高度优先服务和障碍 针对有 SSV 风险的女性退伍军人的研究重点。这项工作还有可能使更广泛的领域受益 存在心理健康问题或其他 SSV 危险因素的女性退伍军人群体。