We have reached a 30-year high in the rate of suicide in the United States. Suicide risk and prevention efforts among women are the focus of a recent Medical Care supplemental issue. Efforts at prevention and recovery have been especially important for the Departments of Defense and Veterans Affairs. As mentioned in the introduction to the supplement, higher rates of suicide have been observed among veteran women [PDF] compared to non-veteran women.
Women Veterans
Women are a growing share of our military force. As stated by Brownley and Dunn in their editorial:
[Women] make up >16% of the active duty force and almost 20% of the National Guard and Reserve force. There are 2 million women veterans living in the US and their numbers are expected to grow to 18% of the total veteran population by 2040.
Women veterans face distinct barriers when accessing services and support, compared to their male counterparts. We need research to support these women, particularly when their needs might not be met by current activities.
Suicide Among Women
The rates of suicide among women have been increasing faster than the general population, even when age-adjusted. As correctly pointed out by O’Brien and Tomoyasu, simply understanding the rates is not enough. We must understand the factors driving the increase in order to improve prevention.
One paper in the supplement by Edgcomb and colleagues describes the novel use of a machine learning algorithm. This algorithm identified risk factors of suicide attempt (and self-harm) after hospitalization. The initial model used EHR data from women with mental illness in a UCLA data repository. The authors replicated the analysis in a New York sample.
The most important predictors of suicide-related readmission were antecedent medical illness, history of suicide-related behavior, age, and history of pregnancy-related mental illness.
Combinations of these predictors were the most consistent in characterizing high-risk hospitalizations.
Recovery Needs
Another paper in the supplement suggests that the process of recovery after a suicide attempt by veterans is likely to vary by gender. Denneson and colleagues find suggestive data “that women emphasize relatedness whereas men emphasize competence.” After 50 interviews, their thematic analysis suggested some gender-related differences in recovery needs:
- Women veterans prioritized their connections with others. The women expressed a wish for mutually supportive relationships in which they could give, as well as receive, emotional support, as well as sharing knowledge and experiences.
- The women wanted to repair their self-worth through self-knowledge and development. They wanted to know, “why they do, think, or feel the things they do.”
- By comparison, men veterans focused on trying to live and do ‘right’ during their recovery.
- Although relationships were as important to men as for women veterans, the men were motivated by feeling needed and accountable to others.
- Regardless of gender, the veterans expressed the desire for a stronger sense of purpose.
The findings have implications for working with veterans recovering after a suicide attempt, the authors believe. For example, women might be more interested in groups or activities that connect them to others with similar experiences. In contrast, men might benefit from goal-oriented approaches that set them up for successful experiences or make them feel accountable to a group.
Where do we go from here?
Research on suicide prevention and recovery, while increasing, still has a long way to go. Even though suicide is the 10th leading cause of death, it has a low base-rate that makes research difficult. There are also many other reasons that research in suicide prevention is hard.
This supplement points the way towards future prevention and recovery efforts. It would be interesting to see how these ideas might play out in existing groups, such as The Mission Continues or Team Red, White & Blue. It is important to remember that while there are particular conditions that disproportionately affect veterans, we should never reduce an entire group to a set of problems. We need to work to reduce stigma while working to reduce suicide and the burden of mental illness.
As a spouse of a veteran with friends who have served their country in the military, this supplement feels personal to me. Only with continued efforts, including funding and collaboration, will we make progress. The writers of this supplement are hopeful that we can augment recent gains in prevention. I am hopeful too.
If you are in crisis, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential. http://www.suicidepreventionlifeline.org
Jess Williams