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Servicewomen and Women Veterans| Volume 32, ISSUE 4, P418-425, July 2022

Women Veterans’ Perspectives on Suicide Prevention in Reproductive Health Care Settings: An Acceptable, Desired, Unmet Opportunity

  • Claire A. Hoffmire
    Correspondence
    Correspondence to: Claire A Hoffmire, PhD, Rocky Mountain MIRECC, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Building G3, Room 189, Aurora, CO 80045.
    Affiliations
    Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, Aurora, Colorado

    Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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  • Lisa A. Brenner
    Affiliations
    Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, Aurora, Colorado

    Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado

    Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado

    Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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  • Jodie Katon
    Affiliations
    Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington

    Department of Health Services, University of Washington, Seattle, Washington
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  • Laurel A. Gaeddert
    Affiliations
    Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, Aurora, Colorado
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  • Christin N. Miller
    Affiliations
    Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, Aurora, Colorado
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  • Alexandra L. Schneider
    Affiliations
    Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, Aurora, Colorado
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  • Lindsey L. Monteith
    Affiliations
    Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, Aurora, Colorado

    Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Published:March 08, 2022DOI:https://doi.org/10.1016/j.whi.2022.01.003

      Abstract

      Background

      Women veterans of reproductive age experience a suicide rate more than double their civilian peers. Developing effective suicide prevention strategies for women veterans requires identifying settings frequented by women veterans where acceptable prevention initiatives can be implemented. Reproductive health care (RHC) settings may provide such an opportunity.

      Methods

      We conducted semi-structured interviews with 21 cisgender women veterans of reproductive age using RHC services provided or paid for by the Department of Veterans Affairs (VA) to understand their beliefs, attitudes, and preferences regarding suicide risk assessment and prevention within these settings. Interview analysis was inductive and used a thematic analysis framework.

      Results

      Four major themes emerged from the interviews: 1) positive patient-provider relationships in RHC settings are important; 2) some women veterans prefer women providers for RHC and suicide risk screening; 3) women veterans’ experiences with VA suicide risk screening and assessment vary; and 4) suicide risk screening and prevention in RHC settings is a desired and acceptable, yet unmet opportunity.

      Conclusions

      Findings from this novel study suggest that VA RHC settings may present a viable milieu for implementing upstream, gender-sensitive, veteran-centric suicide prevention strategies. Future research is needed with VA RHC providers to determine their needs for successfully implementing such strategies.
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      References

        • Birks M.
        • Chapman Y.
        • Francis K.
        Memoing in qualitative research: Probing data and processes.
        Journal of Research in Nursing. 2008; 13: 68-75
        • Bradley K.A.
        • Bush K.R.
        • Epler A.J.
        • Dobie D.J.
        • Davis T.M.
        • Sporleder J.L.
        • Kivlahan D.R.
        Two brief alcohol-screening tests from the Alcohol Use Disorders Identification Test (AUDIT): Validation in a female Veterans Affairs patient population.
        Archives of Internal Medicine. 2003; 163: 821-829
        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        Qualitative Research in Psychology. 2006; 3: 77-101
        • Brownstone L.M.
        • Holliman B.D.
        • Gerber H.R.
        • Monteith L.L.
        The phenomenology of military sexual trauma among women veterans.
        Psychology of Women Quarterly. 2018; 42: 399-413
        • Callegari L.S.
        • Borrero S.
        • Reiber G.E.
        • Nelson K.M.
        • Zephyrin L.C.
        • Sayre G.G.
        • Katon J.G.
        Reproductive life planning in primary care: A qualitative study of women veterans’ perceptions.
        Women’s Health Issues. 2015; 25: 548-554
        • Chuang E.
        • Brunner J.
        • Mak S.
        • Hamilton A.B.
        • Canelo I.
        • Darling J.
        • Yano E.M.
        Challenges with implementing a patient-centered medical home model for women veterans.
        Women’s Health Issues. 2017; 27: 214-220
        • Cohen B.E.
        • Maguen S.
        • Bertenthal D.
        • Shi Y.
        • Jacoby V.
        • Seal K.H.
        Reproductive and other health outcomes in Iraq and Afghanistan women veterans using VA health care: Association with mental health diagnoses.
        Women’s Health Issues. 2012; 22: e461-e471
        • Constand M.K.
        • MacDermid J.C.
        • Dal Bello-Haas V.
        • Law M.
        Scoping review of patient-centered care approaches in healthcare.
        BMC Health Services Research. 2014; 14: 271
        • Crawford J.N.
        • Weitzen S.H.
        • Schulkin J.
        Integrated Women’s Behavioral Health: Recent Literature and Proposed Framework. Professional Psychology: Research and Practice. Advance online publication.
        • Franklin J.C.
        • Ribeiro J.D.
        • Fox K.R.
        • Bentley K.H.
        • Kleiman E.M.
        • Huang X.
        • Nock M.K.
        Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research.
        Psychological Bulletin. 2017; 143: 187-232
        • Frayne S.M.
        • Saechao F.
        • Friedman S.A.
        • Shaw J.G.
        • Romodan Y.
        • Berg E.
        • Haskell S.G.
        Sourcebook: women veterans in the Veterans Health Administration. volume 4: longitudinal trends in sociodemographics, utilization, health profile, and geographic distribution (Vol. 4).
        (Available:)
        • Gaeddert L.A.
        • Schneider A.L.
        • Miller C.N.
        • Monteith L.L.
        • Brenner L.A.
        • Katon J.
        • Hoffmire C.A.
        Recruitment of women veterans into suicide prevention research: Improving response rates with enhanced recruitment materials and multiple survey modalities.
        Research in Nursing & Health. 2020; 43: 538-547
        • Ganzini L.
        • Denneson L.M.
        • Press N.
        • Bair M.J.
        • Helmer D.A.
        • Poat J.
        • Dobscha S.K.
        Trust is the basis for effective suicide risk screening and assessment in veterans.
        Journal of General Internal Medicine. 2013; 28: 1215-1221
        • Hall K.S.
        • Harris L.H.
        • Dalton V.K.
        Women’s preferred sources for primary and mental health care: Implications for reproductive health providers.
        Women’s Health Issues. 2017; 27: 196-205
        • Hoffmire C.A.
        • Denneson L.M.
        Concerning trends in suicide among women veterans point to need for more research on tailored interventions.
        in: Health Services Research & Development, Suicide Prevention, Spring 2018 Forum. 2018 (Available:)
        • Holliday R.
        • Monteith L.L.
        Seeking help for the health sequelae of military sexual trauma: A theory-driven model of the role of institutional betrayal.
        Journal of Trauma and Dissociation. 2019; 20: 340-356
        • Katon J.G.
        • Callegari L.S.
        • Bossick A.S.
        • Fortney J.
        • Gerber M.R.
        • Lehavot K.
        • Gray K.E.
        Association of depression and post-traumatic stress disorder with receipt of minimally invasive hysterectomy for uterine fibroids: Findings from the U.S. Department of Veterans Affairs.
        Women’s Health Issues. 2020; 30: 359-365
        • Katon J.G.
        • Gray K.E.
        • Gerber M.R.
        • Harrington L.B.
        • Woods N.F.
        • Weitlauf J.C.
        • Zephyrin L.C.
        Vasomotor symptoms and quality of life among veteran and non-veteran postmenopausal women.
        Gerontologist. 2016; 56: S40-S53
        • Katon J.G.
        • Hoggatt K.J.
        • Balasubramanian V.
        • Saechao F.
        • Frayne S.M.
        • Mattocks K.M.
        • Zephyrin L.C.
        Reproductive health diagnoses of women veterans using Department of Veterans Affairs health care.
        Medical Care. 2015; 53: S63-S67
        • Katon J.G.
        • Reiber G.
        • Rose D.E.
        • Bean-Mayberry B.
        • Zephyrin L.C.
        • Washington D.L.
        • Yano E.M.
        VA location and structural factors associated with on-site availability of reproductive health services.
        Journal of General Internal Medicine. 2013; 28: 591-597
        • Kimerling R.
        • Pavao J.
        • Greene L.
        • Karpenko J.
        • Rodriguez A.
        • Saweikis M.
        • Washington D.L.
        Access to mental health care among women veterans: Is VA meeting women’s needs?.
        Medical Care. 2015; 53: S97-S104
        • Klap R.
        • Darling J.E.
        • Hamilton A.B.
        • Rose D.E.
        • Dyer K.
        • Canelo I.
        • Yano E.M.
        Prevalence of stranger harassment of women veterans at Veterans Affairs Medical Centers and impacts on delayed and missed care.
        Women’s Health Issues. 2019; 29: 107-115
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The PHQ-9: Validity of a brief depression severity measure.
        Journal of General Internal Medicine. 2001; 16: 606-613
        • Mattocks K.M.
        • Kroll-Desrosiers A.
        • Zephyrin L.C.
        • Katon J.G.
        • Weitlauf J.C.
        • Bastian L.
        • Brandt C.
        Infertility care among OEF/OIF/OND women veterans in the Department of Veterans Affairs.
        Medical Care. 2015; 53: S68-S575
        • Mazzoni S.
        • Brewer S.
        • Durfee J.
        • Pyrzanowski J.
        • Barnard J.
        • Dempsey A.F.
        • O’Leary S.T.
        Patient perspectives of obstetrician gynecologists as primary care providers.
        The Journal of Reproductive Medicine. 2017; 62: 3-8
        • Monteith L.L.
        • Bahraini N.H.
        • Gerber H.R.
        • Holliman B.D.
        • Schneider A.L.
        • Holliday R.
        • Matarazzo B.B.
        Military sexual trauma survivors’ perceptions of Veterans Health Administration care: A qualitative examination.
        Psychological Services. 2018; 17: 178-186
        • Monteith L.L.
        • Holliday R.
        • Brostow D.P.
        • Hoffmire C.A.
        Understanding suicide among female veterans.
        in: Kumar U. The Routledge International Handbook of Military Psychology and Mental Health. 2019: 411-424 (. Routledge. Available:)
        • National Center for Veterans Analysis and Statistics
        Table 1L: Vetpop2016 living veterans by age group, gender, 2015–2045.
        (Available:)
        https://www.va.gov/vetdata/Veteran_Population.asp
        Date: 2017
        Date accessed: December 1, 2020
        • Nowell L.S.
        • Norris J.M.
        • White D.E.
        • Moules N.J.
        Thematic analysis: Striving to meet the trustworthiness criteria.
        International Journal of Qualitative Methods. 2017; 16: 1-13
        • Office of Mental Health and Suicide Prevention
        National strategy for preventing veteran suicide 2018–2028.
        (Available:)
        https://www.mentalhealth.va.gov/suicide_prevention/data.asp
        Date: 2018
        Date accessed: December 1, 2020
        • Office of Mental Health and Suicide Prevention
        2021 National Veteran Suicide Prevention Annual Report.
        (Available:)
        • Posner K.
        • Brown G.K.
        • Stanley B.
        • Brent D.A.
        • Yershova K.V.
        • Oquendo M.A.
        • Mann J.J.
        The Columbia-Suicide Severity rating scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults.
        American Journal of Psychiatry. 2011; 168: 1266-1277
        • Rosland A.
        • Nelson K.
        • Sun H.
        • Dolan E.D.
        • Maynard C.
        • Bryson C.
        • Schectman G.
        The patient-centered medical home in the Veterans Health Administration.
        American Journal of Managed Care. 2013; 19: e263-e272
        • Ryan G.L.
        • Mengeling M.A.
        • Summers K.M.
        • Booth B.M.
        • Torner J.C.
        • Syrop C.H.
        • Sadler A.G.
        Hysterectomy risk in premenopausal-aged military veterans: Associations with sexual assault and gynecologic symptoms.
        American Journal of Obstetrics and Gynecology. 2016; 214: 352.e1-352.e13
        • Skinner H.A.
        The drug abuse screening test.
        Addictive Behaviors. 1982; 7: 363-371
        • Strauss J.L.
        • Miller L.J.
        • Strickland S.
        Applying research to advance suicide prevention in women veterans.
        Medical Care. 2021; 59: S6-S8
        • U.S. Department of Health and Human Services, Office of the Surgeon General, & National Action Alliance for Suicide Prevention
        2012 national strategy for suicide prevention goals and objectives for action.
        (Available:)
        https://www.ncbi.nlm.nih.gov/books/NBK109917/
        Date: 2012
        Date accessed: December 1, 2020
        • Weathers F.W.
        • Litz B.T.
        • Keane T.M.
        • Palmieri P.A.
        • Marx B.P.
        • Schnurr P.P.
        The PTSD Checklist for DSM-5 (PCL-5). National Center for PTSD.
        • Yano E.M.
        • Darling J.E.
        • Hamilton A.B.
        • Canelo I.
        • Chuang E.
        • Meredith L.S.
        • Rubenstein L.V.
        Cluster randomized trial of a multilevel evidence-based quality improvement approach to tailoring VA patient aligned care teams to the needs of women veterans.
        Implementation Science. 2016; 11: 101
        • Zephyrin L.C.
        • Katon J.G.
        • Hoggatt K.J.
        • Balasubramanian V.
        • Saechao F.
        • Frayne S.M.
        • Yano E.M.
        State of reproductive health in women veterans - VA reproductive health diagnoses and organization of care.
        (Available:)
        https://escholarship.umassmed.edu/qhs_pp/1132
        Date: 2014
        Date accessed: December 1, 2020

      Biography

      Claire Hoffmire, PhD, Epidemiologist, co-leads the Advancing Suicide PreventIon for UndeRserved VEterans (ASPIRE) Lab at the VA Rocky Mountain MIRECC for Suicide Prevention, and is Assistant Professor at the University of Colorado School of Medicine. Her research focuses on reducing suicide among historically underrepresented veterans, including women veterans.

      Biography

      Lisa Brenner, PhD, Psychologist, is Director of the VA Rocky Mountain MIRECC for Suicide Prevention, and Professor at the University of Colorado School of Medicine. Her primary area of research is traumatic brain injury, comorbid psychiatric disorders, and negative psychiatric outcomes, including suicide.

      Biography

      Jodie Katon, PhD, Epidemiologist, is an Investigator at the VA COIN for Veteran-Centered and Value-Driven Care and a Research Assistant Professor at the University of Washington School of Public Health. Her research focuses on improving reproductive health care services for women veterans.

      Biography

      Laurel Gaeddert, BS, is a Research Study Coordinator at the VA Rocky Mountain MIRECC for Suicide Prevention. She manages research studies focused on suicide prevention for veterans, including women veterans.

      Biography

      Christin Miller, MPH, is a Data Analyst at the VA Rocky Mountain MIRECC for Suicide Prevention.

      Biography

      Alexandra Schneider, BA, is a Data Analyst at the VA Rocky Mountain MIRECC for Suicide Prevention and Data Manager for the ASPIRE Lab.

      Biography

      Lindsey Monteith, PhD, Psychologist, co-leads the ASPIRE Lab at the VA Rocky Mountain MIRECC for Suicide Prevention and is Associate Professor at the University of Colorado School of Medicine. Her research aims to ensure that suicide prevention initiatives are patient centered, gender sensitive, and trauma informed.