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Principal Investigator: Melissa E Dichter
Organization: PHILADELPHIA VA MEDICAL CENTER
Fiscal Year: 2024
Funding agency: Veterans Affairs
Background. The suicide rate among women Veterans has increased substantially in recent years,
particularly among younger women and those with limited or no engagement in Veterans Health Administration
(VHA) care. The U.S. Department of Veterans Affairs (VA) has invested extensive resources toward preventing
suicide among Veterans, including through the Veterans Crisis Line (VCL). Prior research on Veteran suicide
prevention and VCL use has focused largely on male Veterans. However, research has identified potentially
unique characteristics associated with suicide risk among women Veterans and a need for further investigation
into how to best meet the suicide prevention needs of this population.
Significance/Impact. The objective of this research is to understand and develop recommendations to better
address the suicide prevention needs of women Veterans who utilize the Veterans Crisis Line (VCL). Findings
from this study will inform recommendations for strengthening crisis intervention services to prevent suicide
among women Veterans.
Innovation. The proposed multi-method study will focus on the understudied and vulnerable population of
women Veterans who contact the VCL. We will analyze the rich yet largely unexamined data collected by the
VCL on user and call characteristics, merge VCL data with VHA medical record data for callers who also
access VHA services, and conduct in-depth interviews with women Veteran VCL users to obtain more detailed
understanding of their experiences and perspectives. Findings will inform efforts to better tailor VCL services
to, and increase engagement of, high-risk women Veterans.
Specific Aims. The specific aims are to: (1) describe and compare the demographic and VCL contact
characteristics (reason for call, call outcome, and VCL risk rating) among female and male Veteran VCL users;
(2) examine the relationship between VCL contact characteristics (risk rating, referral, identified needs) and
subsequent fatal and non-fatal suicidal self-directed violence (S-SDV), assessing for variation by Veteran
gender, among female and male Veteran VCL users who use VHA services; (3) understand women Veterans’
experiences with and recommendations regarding VCL services, including the use of VCL as a resource for
both acute and more upstream suicide prevention.
Methodology. This mixed-methods study will utilize (a) administrative data from the VCL, VHA, and Suicide
Data Repository (SDR); and (b) semi-structured interviews with women Veterans who have utilized the VCL.
To address Aim 1, we will conduct statistical analysis of VCL data for prior-year Veteran users with identified
gender (approximately 330,000 contacts per year), comparing demographic and VCL contact characteristics
(reason for contact, severity rating, and contact resolution/referral) by gender. For Aim 2, we will merge VCL
data with VHA health records and SDR data to assess relationships between VCL risk rating and suicidal
ideation, suicide attempts, and suicide, with consideration of other health and service utilization characteristics.
For Aim 3, we will conduct semi-structured telephone interviews with a sample (n = 40) of women Veteran VHA
patients who have used the VCL, and assess: their reasons for contacting the VCL, expectations of VCL,
experience with VCL service and connection with follow-up services, and recommendations for improvements
in suicide prevention services. We will integrate our findings with input from a study-specific stakeholder
advisory board composed of Veterans and clinical and operations partners, to develop recommendations for
enhancing VA’s crisis intervention and broader suicide prevention efforts for women Veterans.
Implementation/Next Steps. In collaboration with partners and Veteran stakeholders, findings will be used to
develop a set of recommendations for clinical enhancement that operations partners can then implement into
policy and practice. Future research will examine the impact of these clinical innovations.
Terms: <Active Follow-up><Acute><Address><Area><Armed Forces Personnel><Caring><Characteristics><Clinical><Clinical Data><Collaborations><Crisis Intervention><Data><Data Banks><Databanks><Economics><Eligibility><Eligibility Determination><Enrollment><Evaluation><Family><Feeling><Feeling suicidal><Female><Female Health><Friends><Gender><Health><Health Services Administration><Health Services Evaluation><Health Services Research><High Risk Woman><Hotlines><Hour><Housing><Interpersonal Violence><Interview><Investigation><Investments><Knowledge><Left><Medical Care Research><Medical Records><Mental Health><Mental Hygiene><Methodology><Methods><Military><Military Personnel><Outcome><Patients><Phone><Policies><Population><Prevention><Prevention Research><Protocol Screening><Psychological Health><Recommendation><Research><Research Priority><Research Resources><Resolution><Resources><Risk><Sampling><Self Direction><Services><Severities><Social Characteristics><Social isolation><Statistical Data Analyses><Statistical Data Analysis><Statistical Data Interpretation><Structure><Suicidal thoughts><Suicide><Suicide attempt><Suicide precaution><Suicide prevention><Telephone><Telephone Hotlines><Telephone Interviews><Text Messaging><United States Department of Veterans Affairs><United States Veterans Administration><Variant><Variation><Veterans><Veterans Administration><Veterans Affairs><Veterans Health Administration><Veterans Health Affairs><Violence><Vulnerable Populations><Woman><Women's Health><Work><active followup><at-risk females><at-risk women><data depository><data repository><data set repository><dataset repository><economic><enroll><expectation><experience><fatal attempt><fatal suicide><feelings><female outcomes><females at high risk><follow up><follow-up><followed up><followup><gender difference><gender-associated difference><health record><help seeking><help-seeking behavior><high risk females><housing instability><implementation strategy><improved><innovate><innovation><innovative><instably housed><intent to die><male><men><military population><non fatal attempt><nonfatal attempt><operation><operations><outcomes among females><outcomes among women><outcomes in females><outcomes in women><prevent><prevent suicidality><prevent suicide><preventing><prevention service><programs><resolutions><service intervention><service utilization><services research><short message service><social><social relationships><statistical analysis><strategies for implementation><suicidal><suicidal attempt><suicidal behavior><suicidal ideation><suicidal risk><suicidal thinking><suicidal women><suicidality><suicidality prevention><suicide behavior><suicide ideation><suicide intervention><suicide rate><suicide risk><suicides><texting><thoughts about suicide><unstable housing><unstably housed><violent><violent behavior><vulnerable group><vulnerable individual><vulnerable people><women at high risk><women's outcomes><young woman>