Characteristics and Context of Veterans Experiencing Serious Suicidal Ideation or Suicide Attempt by Firearm which led to Hospitalization

Abstract

Objective

Suicide by former United States military service members is of great public health concern, and one area, veterans’ suicide attempts involving firearms, is understudied. One group that has a unique perspective on this are veterans with a psychiatric admission following a firearm-related suicide crisis, such as making a suicide plan or a suicide rehearsal with a firearm within the preceding 72 hours. This study seeks to address this gap in the literature by describing the characteristics and context of non-fatal suicide events involving firearms among veterans.

Method

This convergent parallel mixed-methods design study collected both quantitative and qualitative data from male veterans (N = 15) who were hospitalized due to a suicide attempt or serious ideation using a firearm. Veterans admitted to a Veterans Affairs Medical Center (VAMC) were interviewed and asked to complete a survey. Qualitative data on characteristics and context were analyzed using a thematic analysis.

Results

The fifteen male U.S. military veterans described their personal characteristics, such as their beliefs, family beliefs and structure, emotions, and employment status. Most participants were unemployed (n = 10; 67%), divorced (n = 7; 47%) or married (n = 5; 33%). Seven themes related to context emerged from qualitative interviews to include: combat trauma, non-combat trauma and negative life event(s), current and past suicide attempt(s), firearms, substance use, known deaths by suicide, and protective factors for suicide.

Conclusion

Results suggest that engaging support networks and communities is essential when developing programs to promote identification of early warning signs and implementation of interventions or programs for reducing veteran suicide.

Keywords:

• Crisis
• firearm
• suicide attempt
• suicide ideation
• veteran

ACKNOWLEDGEMENTS

The views expressed in this article are those of the author(s) and do not necessarily represent the views of the United States government, Department of Veterans Affairs, Veterans Health Administration (VHA), universities, or other affiliates. The project described was supported by a funds from the VHA Health Service Research and Development grant awarded to Dr. Waliski (Award # PPO 19-289). The Central Arkansas Veterans Health Care System, North Little Rock, Arkansas, provided infrastructure resources.

DISCLOSURE STATEMENT

The authors have no conflicts of interest to disclose. Data is stored, monitored, and available per the Central Arkansas Veterans Healthcare System Institutional Review Board guidelines.

Additional information

Funding

This work was supported by the Department of Veterans Affairs Heath Science Research and Development Grant Award #1I21HX001373-01A1. The results described are based on data analyzed by the authors and do not represent the views of the Department of Veterans Affairs or the United States Government.

Notes on contributors

Angie Waliski

Angie Waliski, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. University of Arkansas for Medical Sciences, Little Rock, AR, USA. Monica M. Matthieu, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA. James C. Townsend, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. Janette McGaugh, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, University of Arkansas for Medical Sciences, Little Rock, AR, USA. Currently works for Ouachita Behavioral Health and Wellness. David A. Adkins, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. Elisabeth M. Skaggs, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. M. Kathryn Allison, University of Arkansas for Medical Sciences, Little Rock, AR, USA. JoAnn Kirchner, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. University of Arkansas for Medical Sciences, Little Rock, AR, USA. VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.

Monica M. Matthieu

Angie Waliski, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. University of Arkansas for Medical Sciences, Little Rock, AR, USA. Monica M. Matthieu, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA. James C. Townsend, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. Janette McGaugh, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, University of Arkansas for Medical Sciences, Little Rock, AR, USA. Currently works for Ouachita Behavioral Health and Wellness. David A. Adkins, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. Elisabeth M. Skaggs, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. M. Kathryn Allison, University of Arkansas for Medical Sciences, Little Rock, AR, USA. JoAnn Kirchner, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. University of Arkansas for Medical Sciences, Little Rock, AR, USA. VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.

James C. Townsend

Angie Waliski, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. University of Arkansas for Medical Sciences, Little Rock, AR, USA. Monica M. Matthieu, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA. James C. Townsend, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. Janette McGaugh, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, University of Arkansas for Medical Sciences, Little Rock, AR, USA. Currently works for Ouachita Behavioral Health and Wellness. David A. Adkins, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. Elisabeth M. Skaggs, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. M. Kathryn Allison, University of Arkansas for Medical Sciences, Little Rock, AR, USA. JoAnn Kirchner, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. University of Arkansas for Medical Sciences, Little Rock, AR, USA. VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.

Janette McGaugh

Angie Waliski, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. University of Arkansas for Medical Sciences, Little Rock, AR, USA. Monica M. Matthieu, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA. James C. Townsend, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. Janette McGaugh, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, University of Arkansas for Medical Sciences, Little Rock, AR, USA. Currently works for Ouachita Behavioral Health and Wellness. David A. Adkins, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. Elisabeth M. Skaggs, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. M. Kathryn Allison, University of Arkansas for Medical Sciences, Little Rock, AR, USA. JoAnn Kirchner, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. University of Arkansas for Medical Sciences, Little Rock, AR, USA. VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.

David A. Adkins

Angie Waliski, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. University of Arkansas for Medical Sciences, Little Rock, AR, USA. Monica M. Matthieu, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA. James C. Townsend, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. Janette McGaugh, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, University of Arkansas for Medical Sciences, Little Rock, AR, USA. Currently works for Ouachita Behavioral Health and Wellness. David A. Adkins, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. Elisabeth M. Skaggs, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. M. Kathryn Allison, University of Arkansas for Medical Sciences, Little Rock, AR, USA. JoAnn Kirchner, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. University of Arkansas for Medical Sciences, Little Rock, AR, USA. VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.

Elisabeth M. Skaggs

Angie Waliski, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. University of Arkansas for Medical Sciences, Little Rock, AR, USA. Monica M. Matthieu, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA. James C. Townsend, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. Janette McGaugh, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, University of Arkansas for Medical Sciences, Little Rock, AR, USA. Currently works for Ouachita Behavioral Health and Wellness. David A. Adkins, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. Elisabeth M. Skaggs, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. M. Kathryn Allison, University of Arkansas for Medical Sciences, Little Rock, AR, USA. JoAnn Kirchner, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. University of Arkansas for Medical Sciences, Little Rock, AR, USA. VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.

M. Kathryn Allison

Angie Waliski, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. University of Arkansas for Medical Sciences, Little Rock, AR, USA. Monica M. Matthieu, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA. James C. Townsend, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. Janette McGaugh, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, University of Arkansas for Medical Sciences, Little Rock, AR, USA. Currently works for Ouachita Behavioral Health and Wellness. David A. Adkins, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. Elisabeth M. Skaggs, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. M. Kathryn Allison, University of Arkansas for Medical Sciences, Little Rock, AR, USA. JoAnn Kirchner, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. University of Arkansas for Medical Sciences, Little Rock, AR, USA. VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.

JoAnn Kirchner

Angie Waliski, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. University of Arkansas for Medical Sciences, Little Rock, AR, USA. Monica M. Matthieu, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA. James C. Townsend, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. Janette McGaugh, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, University of Arkansas for Medical Sciences, Little Rock, AR, USA. Currently works for Ouachita Behavioral Health and Wellness. David A. Adkins, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. Elisabeth M. Skaggs, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA, VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. M. Kathryn Allison, University of Arkansas for Medical Sciences, Little Rock, AR, USA. JoAnn Kirchner, Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA. University of Arkansas for Medical Sciences, Little Rock, AR, USA. VA Quality Enhancement Research Initiative (QUERI) for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.