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：在2000年至2014年之间，女退伍军人的自杀率增加了63％ - 显着 在PURIOD期间，男性退伍军人观察到的30％。 研究危险因素，护理障碍和护理利用的工作，研究很少。 这些问题与女性有关。 横截面分析和其他方法的局限性。 健康和社会心理因素，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。 直接有价值的预防自杀资源，并帮助VHA解决这一日益严重的问题。 目标：我们研究的目的是使用大型，大型， 全国男性和男性退伍军人样本，最近非致命的自杀自我指导的暴力（SSV：致命） 我们的目标是：1） 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， 应对策略和症状随着时间的流逝而随着时间的流逝而改变，男性和男性退伍军人处于SSV风险。 方法：这将是最早的混合方法，具有SSV史的退伍军人的纵向人群研究，以及 以公共卫生和社会生态框架为指导，以促进检查近端和 SSV的远端风险。 事件记录在VA公司数据仓库（CDW）中的自杀行为报告中 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 自杀思想和SSV，他们在恢复过程，障碍和恢复需求和经验 促进者要照顾，以及临床医生和医疗保健系统如何更好地识别和满足 像他们一样的退伍军人。 女性退伍军人中SSV风险模型，直接告知调查结构选择，定量 分析计划和纵向调查的定量发现。 行为CDW识别和注册至少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个月的随访时的健康和社会心理措施。 通过定性发现的知识，包括社会心理和与健康相关的措施，例如应对 功效，内部冲突，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。 事件（主要结果：基线之后的SSV事件），将通过多个来源确定。 健康和利用数据将从CDW和Medicald Progress Notes获得 分析将使用潜在变量建模在多种模型模型模型模型模型中 男女自杀风险的小组格式测试模型。 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如何 大会变量通过性别聚集在一起。 意义：研究结果，有促销，无法获得的证据，以支持选择 间隔目标以及确定高优先级服务和护理直接计划的障碍 对SSV风险的女性退伍军人的研究优先事项也有可能使Boader受益 具有精神健康状况的女性退伍军人的人口或SSV的其他风险因素。