Perspectives of Female Veterans, VHA Providers, and Family Members on Preventing Firearm-Inflicted Suicides among Female Veterans

Va Eastern Colorado Health Care System, Aurora CO

Investigators

Abstract

BACKGROUND: In 2017, the age-adjusted suicide rate for female Veterans was 2.2 times that of female non- Veterans. This may relate to a substantial increase in the proportion of female Veterans using firearms as their means of death, particularly among women using Veterans Health Administration (VHA) care. Firearms are now the leading means of suicide among female Veterans. Lethal means safety (LMS; i.e., reducing access to lethal means when suicide risk is elevated) is a highly-recommended suicide prevention strategy. Yet prior firearm LMS research has primarily focused on male Veterans, despite female Veterans idiographically differing in their firearm access, ownership, and use. Data suggest that female Veterans more often obtain firearms and store them loaded and nearby to increase safety following interpersonal violence (e.g., sexual assault, intimate partner violence). Given high rates of interpersonal violence among female Veterans, it is critical to ensure firearm LMS efforts are tailored and delivered to female Veterans from a trauma-focused lens. Further, nearly 40% of female Veterans report having household firearms that they do not personally own, which often occurs through spouses or partners. Thus, including family members in firearm LMS efforts may be particularly important for female Veterans. Prior research also suggests that Veterans rarely initiate firearm discussions with their VHA providers, who seldomly assess firearm access, despite its association with suicide risk. Thus, a multi-systemic perspective that encompasses the perspectives of female Veterans, their spouses or partners, and VHA providers is essential. SIGNIFICANCE/IMPACT: Effective suicide prevention necessitates a well-informed, patient-centered approach. Yet firearm knowledge specific to female Veterans remains limited and has largely relied upon extrapolating data from male Veterans. By understanding the experiences and perspectives of female Veterans, their spouses/partners, and VHA providers, findings will inform development of gender-sensitive conceptual understanding and interventions for approaching firearm LMS in this population. Findings can be used to delineate a tailored firearm LMS intervention for female Veterans that can subsequently be piloted for acceptability, feasibility, and ultimately efficacy. INNOVATION: This study is innovative in its focus on understanding the inherent needs and preferences of female Veterans, rather than extrapolating findings from male Veterans. It will be the first to interview female Veterans, spouses and partners, and VHA providers regarding experiences and preferences for firearm LMS. This is highly innovative as spouses and partners have rarely been included in Veteran suicide prevention research, despite increasing the likelihood of female Veterans’ firearm access. Findings are expected to result in knowledge essential for developing a gender-specific conceptualization and intervention for addressing firearm LMS with female Veterans to ultimately provide a patient-centered approach to a high-priority, understudied problem. SPECIFIC AIMS: Our aims are to: (1) Describe female Veterans’ experiences, perspectives, and preferences regarding firearm access and LMS, and explore the role of interpersonal violence within this; (2) Explore the perspectives and experiences of female Veterans’ partners and spouses regarding engaging in firearm LMS (e.g., ability, willingness); and (3) Describe VHA mental health (MH) and primary care (PC) providers’ experiences and perspectives on discussing firearm access and LMS with female Veterans, including challenges and facilitators. METHODOLOGY: Qualitative interviews will be conducted with: female Veterans who own firearm(s) or reside in a household with firearm(s) and have experienced suicidal ideation or attempt (Aim 1); partners and spouses of female Veterans (Aim 2); and VHA MH and PC providers who work with female Veterans (Aim 3). IMPLEMENTATION/NEXT STEPS: Results will be synthesized to develop a patient-centered, gender-sensitive firearm LMS intervention for female Veterans, and resources for family members and VHA providers. Key operations partners will be engaged in this process to ensure feasible recommendations and wide dissemination of findings.