An estimated 22 Veterans die from suicide daily with approximately 67% of those deaths occurring by means of firearms. However, there has been very little research designed to identify modifiable factors or inform programs that could reduce the rate of firearm-related suicide. Despite increased funding to support research and implement programs to prevent suicide among Veterans who use VHA services, comparatively little is known about the context and characteristics of risk among those in suicidal crisis and why Veterans overwhelmingly choose firearms as their method of suicide. VHA is unique in the existence of a suicide event surveillance system that documents attempted and completed suicides including the means associated with a suicide attempt or serious thoughts of suicide. This affords the opportunity to learn from those Veterans who have attempted or had serious thoughts of suicide by firearms. Thus, this study is unique in that it will offer insight about suicide by firearms and about preventing suicide by firearms from the perspective of the Veteran. Research Plan: This study uses semi-structured interviews with Veterans who have survived suicide attempts by firearm or who have experienced serious thoughts of suicide by means of firearm to bridge the gaps of knowledge about the context and characteristics of non-fatal suicide events involving firearms, identify facilitators and barriers to help-seeking and disclosure of intent prior to the event, and using this information to develop recommendations for reducing access to firearms during periods of extreme emotional distress. The PI will work with the CAVHS Suicide Prevention (SP) office to identify survivors of suicide attempts or serious suicide ideations in central Arkansas using the VA Suicide Surveillance System database. The SP Coordinator or Case Manager will correspond with the Veteran's clinician to determine if he or she is clinically able to participate in the interview. If the Veteran is clinically able to participate in the study, the SP Case Manager will notify SP administrative support staff to send a letter to the Veteran's home informing the Veteran of the study. Once a Veteran has been sent a letter informing him or her of the study, he or she may call the SP coordinator for more information and/or to opt-in to the study. Participant interviews will be conducted in person or by phone depending on the participant's preference. Clinical Relevance: At this time, we do not have a clear understanding of why Veterans are more likely to choose firearms as a method for suicide or how to prevent suicide by firearms. Findings from this study will identify the context of suicide events involving firearms, the reasons for selecting a firearm, the process for obtaining access to the firearm, the use and attitudes toward safety devices such as gun safety locks, and consideration of other methods (i.e. strangulation, overdose, etc.). This study will also seek to identify Veteran preferences for clinical practices related to counseling on limiting access to firearms in the home, identify how family and friends could assist Veterans through gun safety practices, and identify recommendations for modifications to existing clinical practices to reduce risk for suicide associated with firearms from the Veteran. This study is unique in that it offers insight about suicide by firearms and about preventing suicide by firearms from the perspective of the Veteran that has survived or seriously contemplated a suicide attempt by firearm. Study results could be used to inform further research into the effectiveness of current prevention strategies and the development and implementation of future prevention efforts. Therefore these findings are of direct relevance to the VA's Suicide Prevention Program. Relevance to HSR&D: This pilot study addresses the HSR&D priority area of mental and behavioral health and its special interest in innovative approaches to improve earlier identification and treatment of post- traumatic stress disorders and suicidality.
Suicide prevention is a priority topic for Veterans Affairs funded research, and identifying strategies to reduce mortality involving firearms is consistent with the goals and objectives of the 2012 National Strategy for Suicide Prevention. At this time, we do not have a clear understanding of why Veterans are more likely to choose firearms as a method for suicide. This research will identify the context of suicide events involving firearms, the reasons for selecting a firearm, the process for obtaining access to the firearm, the use and attitudes toward safety devices such as gun safety locks, and the probability of suicide event using methods other than firearms. Therefore, this study is unique in that it offers insight about suicide by firearms and its prevention by conducting key informant interviews with Veterans who have had serious suicidal ideations using a firearm or survived a suicide attempt by firearm.