Advancing Suicide Prevention for Female Veterans

背景：女性退伍军人的自杀率在2000至2014年间增加了63%--显著 高于这一时期男性退伍军人30%的增幅。尽管有大量的 调查退伍军人中的风险因素、护理障碍和护理利用情况的工作，很少有研究检查 这些问题与女性有关。现有的研究一直受到女性样本量小的限制， 横断面分析和其他方法学的局限性。因此，令人惊讶的是，我们对 与自杀相关的健康和心理社会因素、护理障碍和医疗保健利用模式 女性退伍军人的行为。需要关于女性自杀风险和她们的医疗保健利用的数据 引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：我们研究的目标是提供针对性别定制的自杀预防方法，使用大型、 最近有非致命性自杀性自我定向暴力(SSV：致命)的男女退伍军人全国样本 和非致命的自杀未遂)。我们的目标是：1)开发和测试女性和男性患病风险的解释模型 在12个月内重复SSV，以及2)确定医疗保健利用模式的异同， 应对策略，以及SSV高危男性和女性退伍军人随时间的症状变化。 方法：这将是第一次对有SSV病史的退伍军人进行混合方法的纵向队列研究，以及 以公共卫生、社会生态框架为指导，以便于检查近端和 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，为他们接种非致命性SSV 这一事件被记录在退伍军人管理局企业数据仓库(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中的经历，障碍和 以及临床医生和医疗保健系统如何更好地识别和解决 退伍军人喜欢他们。我们将使用扎根的理论方法来分析成绩单，以制定一个理论 女性退伍军人SSV风险模型，直接告知调查结构选择，定量 分析计划和对量化结果的解释。对于纵向调查，我们将使用自杀 CDW的行为报告识别和招募至少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测量。自我报告调查问卷将是 以定性调查结果为依据，包括心理社会和健康相关措施，如应对 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。参与者将被跟踪12个月以评估并记录所有SSV 事件(主要结果：基线之后的SSV事件)，将通过多个来源确定。 健康和利用率数据将从CDW和病历进度记录中获得。主要数量 分析将使用潜在变量建模框架来同时对多个 以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和潜在类 过渡分析，以确定对医疗保健利用的不同响应，以及某些健康和 心理社会变量按性别聚集在一起。 意义：这项研究的结果将提供以前没有的证据来支持选择 干预目标以及确定高优先级服务和关爱障碍，以指导规划和 有SSV风险的女性退伍军人的研究优先事项。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危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.