Gender differences in Veteran reintegration and associated suicide risk

背景：兵役分离后的前四年，退伍军人正在重新融入平民 生命，是退伍军人自杀的最高风险时期。退伍军人还面临着一些重新融入社会的问题 恢复平民生活角色的挑战。重要的是，女性和男性退伍军人可能会经历这一时期 不同.这项研究将为有自杀风险的退伍军人的重返社会经验提供有价值的数据 在退伍军人重返社会的六个关键领域，确定与增加的 自杀风险，并阐明在重返社会的经验和相关的自杀风险的性别差异。 意义：这项研究将增加我们对退伍军人重返社会期间自杀风险的理解， 支持在此期间开展专门针对退伍军人妇女的预防工作。这些数据 需要告知最近的行政命令和退伍军人事务部倡议，要求加强自杀预防工作 这项研究的结果将确定退伍军人中最多的亚组， 需要宝贵的资源，哪些重返社会的挑战特别棘手， VA在这一重要人群中制定选择性预防方法。 创新与影响：这项研究超越了自杀风险的横断面研究， 近年来的退伍军人，是精心设计的研究性别差异的自杀风险，建立在 自杀预防的研究和理论以及自杀风险性别差异的新发现。 此外，这项研究是创新的，它的联系VA国防部数据集，以确定一个国家的样本，新的 分离的退伍军人在自杀的风险增加谁不一定从事VA医疗保健。 具体目标：本研究的具体目标是：1）模拟在- 风险退伍军人识别人口亚组（例如，稳定、恶化、改善），并审查性别 2）确定目标1中确定的轨迹之间的关联， 女性和男性中与自杀风险相关的诱发因素，以及3）确定 目标1中确定的轨迹和自杀风险的发展或恶化（自杀意念，自杀 认知、自杀企图）和按性别进行的任何效应测量修改。 方法：这是一项全国性的队列调查研究。我们将招募2,000名退伍军人， 服务在过去六个月内，使用VA-DoD退伍军人身份存储库（VAIDENTITY REpository，VAIDENTITY REpository）数据识别。我们将 对妇女进行过度抽样，以招募大约一半妇女的队列。我们也会对风险进行过度抽样 通过DaVINCI可获得的国防部（DoD）卫生保健数据中可用的指标（即，之前 精神健康住院/门诊就诊、急诊科就诊、其他门诊就诊）。完成后 基线调查，参与者将在36个月的随访期内完成6项额外调查。 调查将包括评估重返社会挑战六个核心领域运作情况的措施 （心理和身体健康，身份/角色谈判，关系质量，财务状况，灵性）作为 以及与自杀风险增加相关的诱发因素和评估自杀风险的措施 （自杀意念、自杀认知、自杀企图）。主要分析将确定重返社会的轨迹， 包括任何性别差异，检查与自杀相关的诱发因素， 恶化的轨迹，并检查与重返社会轨迹相关的自杀风险结果。 下一步：本研究中收集的数据将直接告知许多VA倡议，立法和最近的 行政命令要求通过提供 必要的数据，以确定退伍军人的自杀风险增加和他们各自的需求亚组- 指导宝贵的资源。弗吉尼亚州心理健康和自杀预防办公室和弗吉尼亚州 社会工作是这些努力的强有力伙伴，将支持传播和执行调查结果。

Background: The first four years after military service separation, while Veterans are reintegrating into civilian life, is the highest risk period for suicide among Veterans. Veterans also face a number of reintegration challenges resuming civilian life roles. Importantly, women and men Veterans may experience this period differently. This study will provide valuable data on the reintegration experiences of Veterans at risk for suicide across six key domains of Veteran reintegration, identify reintegration experiences associated with increased suicide risk, and elucidate gender differences in reintegration experiences and associated suicide risk. Significance: This study will increase our understanding of suicide risk during Veteran reintegration and will support development of prevention efforts tailored for women Veterans during this period. These data are needed to inform recent executive orders and VA initiatives calling for increased suicide prevention efforts among reintegrating Veterans; findings from this study will identify subgroups of reintegrating Veterans most in need of valuable resources and which reintegration challenges are especially problematic and when – enabling VA to develop selective prevention approaches within this important population. Innovation & Impact: This study moves the field beyond cross-sectional studies of suicide risk among Veterans of recent eras and is carefully designed to study gender differences in suicide risk, building on the body of research and theory in suicide prevention and emerging findings of gender differences in suicide risk. Furthermore, this study is innovative in its linking of VA-DoD datasets to identify a national sample of newly separated Veterans at increased risk of suicide who are not necessarily engaged in VA healthcare. Specific aims: The specific aims of this study are to: 1) Model the trajectories of reintegration challenges of at- risk Veterans to identify population subgroups (e.g., stable, deteriorating, improving) and examine gender differences in reintegration experiences, 2) Identify associations between trajectories identified in Aim 1 and suicide-risk-related predisposing factors among women and men, and 3) Identify associations between trajectories identified in Aim 1 and development, or worsening, of suicide risk (suicidal ideation, suicide cognitions, suicide attempts) and any effect measure modification by gender. Methodology: This is a national cohort survey study. We will enroll a cohort of 2,000 Veterans separating from service in the prior six months, identified using the VA-DoD Veteran Identity Repository (VADIR) data. We will oversample for women to enroll a cohort that is approximately half women. We will also oversample for risk indicators available in Department of Defense (DoD) healthcare data available through DaVINCI (i.e., prior mental health inpatient/outpatient visit, emergency department visit, other outpatient visit). After completing the baseline survey, participants will complete 6 additional surveys over the course of a 36 month follow up period. Surveys will include measures that assess functioning in the six core domains of reintegration challenges (mental and physical heath, identity/role negotiation, relationship quality, financial well-being, spirituality) as well as predisposing factors associated with increased risk for suicide and measures assessing suicide risk (suicidal ideation, suicide cognitions, suicide attempts). Main analyses will identify the reintegration trajectories, including any gender differences, examine the suicide-related predisposing factors associated with deteriorating trajectories, and examine suicide risk outcomes associated with reintegration trajectories. Next steps: Data gathered in this study will directly inform the many VA initiatives, legislation, and recent executive orders calling for increased suicide prevention efforts among reintegrating Veterans by providing the necessary data to identify subgroups of Veterans at increased risk of suicide and their respective needs – directing valuable resources. The VA Office of Mental Health and Suicide Prevention and the VA Office of Social work are strong partners in these efforts and will support dissemination and implementation of findings.