Accepted for/Published in: JMIR Research Protocols
Date Submitted: Aug 3, 2023
Date Accepted: Aug 11, 2023
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The Effects of Suicide Exposure on Mental Health Outcomes among Post-9/11 Veterans: Protocol for an Explanatory Sequential Mixed Methods Study
ABSTRACT
Background:
The toll associated with suicide goes well beyond the individual who died. This study focuses on a risk factor for veteran suicide that has received little prior empirical attention – exposure to the suicide death of another person.
Objective:
The study’s primary objective is to describe the mental health outcomes associated with suicide exposure among veterans who served on active duty after September 2001 (“post-9/11”). The secondary objective is to elucidate why some veterans develop persistent problems following suicide exposure while others do not.
Methods:
This is an explanatory sequential mixed methods study of a nationally representative sample of post-9/11 veterans enrolled in Department of Veterans Affairs (VA) healthcare. Our sampling strategy was designed for adequate representation of women and American Indian/Alaskan Native veterans to allow for examination of associations between suicide exposure and outcomes within these groups. Primary outcomes comprise mental health problems associated with trauma and loss (posttraumatic stress disorder; prolonged grief disorder), as well as suicide precursors (suicidal ideation, attempts, and planning). Data collection will be implemented in three waves. Wave 1 will field a brief survey to a national probability sample to assess exposure history (suicide, other sudden death, neither) and exposure characteristics (e.g., closeness with the decedent) among 11,400 respondents. Wave 2 will include approximately 4,500 Wave 1 respondents, stratified by exposure history (suicide, other sudden death, neither), to assess health outcomes and other variables of interest. Wave 3 will involve interviews with a purposive subsample of 32 respondents exposed to suicide who differ in mental health outcomes. We will supplement survey and interview data with Department of Veterans Affairs (VA) administrative data on diagnoses, reported suicide attempts, and healthcare utilization.
Results:
The research began July 1, 2022 and will end June 30, 2026. This is the only national, population-based study of suicide exposure in veterans and the first designed to study differences by sex and race. Comparing those exposed to suicide to those exposed to sudden death for reasons other than suicide (e.g., combat) and those unexposed to any sudden death may allow for identification of the common and unique contribution of suicide exposure to outcomes and help seeking.
Conclusions:
Integrating survey, qualitative and VA administrative data to address significant knowledge gaps regarding the effects of suicide exposure in a national sample will lay the foundation for interventions to address the needs of individuals affected by a suicide death, including women and American Indian/Alaskan Native veterans. Clinical Trial: N/A
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