Gender differences in Veteran reintegration and associated suicide risk

退伍军人重返社会和相关自杀风险的性别差异

• 批准号: 10538780
• 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: 2022
• 资助国家: 美国
• 起止时间: 2022-11-01 至 2027-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10538780
• 关键词: Affect; Area; Baseline Surveys; Categories; Classification; Cognition; Cohort Studies; Cross-Sectional Studies; Data; Data Set; Department of Defense; Deterioration; Development; Dimensions; Disease susceptibility; Disparity; Dissemination and Implementation; Emergency department visit; Employee; Employment; Enrollment; Face; Feeling suicidal; Gender; Health; Healthcare; Individual; Individual Differences; Inpatients; Institution; Left; Life; Life Cycle Stages; Link; Longitudinal Studies; Longitudinal Surveys; Measurement; Measures; Mediation; Mental Health; Methodology; Modeling; Modification; Outcome; Outpatients; Parents; Participant; Pattern; Personal Satisfaction; Population; Predisposing Factor; Prevention; Prevention approach; Prevention strategy; Probability; Process; Recording of previous events; Research; Research Design; Resources; Risk; Role; Sampling; Services; Severities; Social Work; Spirituality; Statutes and Laws; Stress; Subgroup; Suicide; Suicide attempt; Suicide prevention; Surveys; Time; Trauma; Veterans; Visit; Woman; Work; base; cohort; data repository; design; experience; falls; follow-up; gender difference; high risk; improved; innovation; men; military service; mortality risk; personalized approach; physical conditioning; psychologic; resilience; selective prevention; suicidal morbidity; suicidal risk; suicide rate; surveillance data; systematic review; theories

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.

背景：退伍军人退役后的头四年，退伍军人正在重新融入平民生活 一生中，是退伍军人中自杀风险最高的时​​期，许多退伍军人也面临着重新融入社会的问题。 重要的是，女性和男性退伍军人可能会经历这一时期。 不同的是，这项研究将为有自杀风险的退伍军人重新融入社会的经历提供有价值的数据。 在退伍军人重返社会的六个关键领域中，确定与增加的退伍军人重返社会经历相关的经历 自杀风险，并阐明重返社会经历和相关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了解，并将 支持在此期间制定针对女性退伍军人的预防工作。 需要为最近的行政命令和退伍军人事务部倡议提供信息，呼吁加强自杀预防工作 在重新融入社会的退伍军人中；这项研究的结果将确定重新融入社会的退伍军人的亚组 需要宝贵的资源，哪些重返社会挑战尤其成问题，以及何时 – 启用 VA 在这一重要人群中制定选择性预防方法。 创新与影响：这项研究使该领域超越了自杀风险的横断面研究 近代退伍军人的精心设计，旨在研究自杀风险的性别差异，建立在 自杀预防的研究和理论体系以及自杀风险性别差异的新发现。 此外，这项研究的创新之处在于它连接了 VA-DoD 数据集，以确定新的国家样本 自杀风险较高的退伍军人不一定参与退伍军人事务部医疗保健。 具体目标：本研究的具体目标是： 1）模拟重新融入社会挑战的轨迹 - 风险退伍军人识别人口亚组（例如，稳定、恶化、改善）并检查性别 重返社会经历的差异，2) 确定目标 1 和目标 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) 确定两者之间的关联 目标 1 中确定的轨迹以及自杀风险的发展或恶化（自杀意念、自杀 认知、自杀企图）以及任何影响测量因性别而改变的情况。 方法：这是一项全国队列调查研究，我们将招募 2,000 名退伍军人组成的队列。 我们将使用 VA-DoD 退伍军人身份存储库 (VADIR) 数据确定前六个月的服务。 对女性进行过度抽样，以招募大约一半女性的队列，我们​​还将针对风险进行过度抽样。 通过 DaVINCI 提供的国防部 (DoD) 医疗保健数据中提供的指标（即之前的 心理健康住院/门诊就诊、急诊科就诊、其他门诊就诊后）。 基线调查后，参与者将在 36 个月的随访期内完成 6 项额外的调查。 调查将包括评估重返社会挑战的六个核心领域的运作情况的措施 （心理和身体健康、身份/角色谈判、关系质量、财务状况、灵性） 以及与自杀风险增加相关的诱发因素以及评估自杀风险的措施 （自杀意念、自杀认知、自杀企图）。主要分析将确定重新融入社会的轨迹， 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。 后续步骤：本研究中收集的数据将直接为退伍军人管理局的许多举措、立法和最近的进展提供信息 行政命令呼吁加强重返社会退伍军人的自杀预防工作，提供 必要的数据来确定自杀风险较高的退伍军人亚群及其各自的需求 - 指导宝贵的资源。 社会工作是这些努力的强有力的合作伙伴，并将支持研究结果的传播和实施。