Undated file photo of Oregon Health & Science University.
Courtesy of Michael McDermott / OHSU
According to the Centers for Disease Control & Prevention, veterans have a 57% higher risk of suicide than the general population. But little is known about how that risk differs between men and women who have served. In the first study of its kind, researchers at Oregon Health & Science University followed a group of veterans for roughly a year after a nonfatal suicide attempt. They found that the women who were surveyed reported more social rejection and lower levels of self-compassion than men, suggesting a higher risk of another attempt.
Lauren Denneson is a professor of psychiatry at OHSU and associate director of the Center to Improve Veteran Involvement in Care at the VA Portland Health Care System. She is the lead author of the study and joins us with more details.
Note: If you’re a veteran in crisis or concerned about one, contact the Veterans Crisis Line to receive 24/7 confidential support. There are several ways to reach responders, and you don’t need to be enrolled in VA benefits or health care to access them. You can dial 988 then press 1, text 838255 or chat online at VeteransCrisisLine.net/Chat
In general, if you or someone you know may be considering suicide, contact the Suicide and Crisis Lifeline by dialing 988, or the Crisis Text Line by texting HOME to 741741.
Note: This transcript was computer generated and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. According to the Centers for Disease Control and Prevention, veterans have a 57% higher risk of suicide than the general population. But not that much is known about how that risk differs between men and women who have served. In the first study of its kind, researchers at OHSU followed a group of veterans for roughly a year after a non-fatal suicide attempt. They found that women reported more social rejection and lower levels of self-compassion than men, suggesting a higher risk of another attempt. Lauren Denneson is a professor of psychiatry at OHSU and the associate director of the Center to Improve Veteran Involvement in Care at the VA Portland Health Care System. She’s the lead author of this new study and joins us with more details. It’s great to have you on Think Out Loud.
Lauren Denneson: Hi. Thanks for having me.
Miller: Thanks for joining us. And I should say, before our conversation, to folks listening – if you’re a veteran in crisis, or if you’re concerned about one, you can contact the veterans’ crisis line to receive 24/7 confidential support. There are a few ways to get help, and you don’t have to be enrolled in VA benefits or healthcare to access the help. You can call 988, then press 1, you can chat online at veteranscrisisline.net/chat, or you can text 838255.
Lauren Denneson, my understanding is that often people don’t report suicide attempts. How did you find people to enroll in this study?
Denneson: That’s a great question. The VA has a really robust surveillance system so that we can make sure that we’re tracking veterans who might be at risk. And one of those things that we do is document whenever a veteran reports suicidal ideation or a suicide attempt. We keep track of that in the medical record.
Miller: So if someone, in answer to a question from their primary care doctor, says that they’re considering suicide, that could be something that’s tracked, and then you can look at that data and you would follow up with people?
Denneson: Yeah, it helps clinicians understand risk among their patients. But it also helps us learn more about suicide prevention in the veteran population.
Miller: Once you found people who had attempted suicide, and you were putting your study together, the idea here was a longitudinal one – you’re going to check in with people over the course of a year. How did you decide what kinds of psychological or social factors were most important to zero in on?
Denneson: I’m glad you asked that, because our study was pretty unique in that we actually brought veterans in who had recently attempted suicide. We interviewed them about their suicide attempt and about the experiences that led to their attempt. And in this way, we really let the veterans tell us what was important, what was contributing to their suicide risk, instead of us, as researchers thinking, " I think this might be important, or this other thing might be important.” So it was really like a bottom-up approach to deciding what types of factors we would include in our longitudinal survey.
Miller: Were there significant differences in the states of mind, broadly, of men and women immediately before their suicide attempts?
Denneson: Yeah, one of the things that really stood out to us, that was a stark difference when we compared the data between women and men from our qualitative interviews, was that women tended to really internalize the negative things that they had experienced. [They] said things that reflected a real sense of self-loathing or that they didn’t deserve to live, they didn’t deserve to be here.
The men, on the other hand, also expressed quite a strong sense of failure and frustration. But it was much more externalized and a frustration with not being able to achieve the things they wanted to achieve. [They] said things like, “I’m just done with it. This is stupid.” You know, were really done struggling with the fight, I suppose you could say.
Miller: You looked into something known as “self-compassion,” which, I think I understand that phrase, as a layperson. But what do you mean as a clinician when you use that word, self-compassion?
Denneson: I think it’s similar to what you might think as a layperson. It’s essentially being able to cut yourself some slack or give yourself grace in the face of challenges in life. And it is one of the constructs that we use to try to capture the difference that I was just describing, where it really felt like the women had experienced a lot of challenges and negative experiences in their lives, but they took that on as their fault. And that was a contrast that we saw between the women and the men, where the men didn’t seem to take it on as their own fault as in the same way.
Miller: I can boil that down to be the relationship with oneself. You also looked at the differences in men and women in the interpersonal relationships they had with other people after their suicide attempts. What did you find out?
Denneson: We essentially heard a lot of … we didn’t hear just about their relationships after their attempt, but we heard a lot about their relationships, broadly. And the thing that stood out the most in that regard was that women were really experiencing a lot more harm from their relationships, which is actually really critical because in health psychology literature, we know that women tend to reach out to their network for coping and support when in times of crisis. And that works great when you have a really great social network. But when your social network is toxic, it can be really detrimental. One of the things that we heard from one of the women was, after a miscarriage, that she had gone to her husband for support, and not only was he not supportive, he actually held a gun to her head.
Miller: That’s obviously a very specific and very traumatic instance. Broadly, what’s the connection between the kind of social rejection that you found is higher among women than men, and the likelihood of future suicide attempts?
Denneson: That was really borne out in our survey data. We conceptualized the things that we were hearing in our qualitative data about a lot of this social rejection, into this measure of social rejection. We looked at all of the different things that we had conceived of as possibly contributing to someone’s suicidal thoughts or a subsequent suicide attempt. And at the center of that was this construct that we had conceived, that we labeled psychological distress. And this was made up of things like stress and post-traumatic stress disorder symptoms, and depression and anxiety. And the the thing that we found was that, especially among women, the relationship between social rejection and psychological stress was very strong, and that it was psychological distress that was actually driving a subsequent suicide attempt.
Miller: What does this research, taken as a whole, suggest to you clinicians or whole systems could do differently with suicide prevention as the ultimate goal?
Denneson: I think we need to engage with the resources, the programs and the therapies that we have that already address healthy relationships and self compassion. But also looking a little bit more broadly, beyond the one-on-one individual level type approaches, and thinking about a more socio-ecological approach which talks about intervening at the relationship, community and systems levels. And going all the way up to embracing the public health approach to change systems and norms and things that contribute to intimate partner violence, for example.
Miller: We just have about a minute left. What message do you have for friends, colleagues or family members of people with suicidal ideation? What do you want them to keep in mind?
Denneson: I would say that the first thing that I would recommend is to really be that source of support for that person, if you’re concerned about someone, and just generally being a good human being is a great thing. And by being a good source of support, I mean, listening without judgment, treating them like a valued member of your family or your friend network. And then also, don’t be afraid to ask the question, if you’re really concerned about someone: “Are you having thoughts of suicide?” Our studies show that asking about suicidal thoughts doesn’t increase their risk, and in fact, can make them feel relief that they have someone to open up to.
Miller: Lauren Denneson, thank you very much.
Denneson: Thank you.
Miller: Lauren Denneson is a professor of psychiatry at OHSU and associate director of the Center to Improve Veteran Involvement in Care at the VA Portland Health Care System.
Again, as a reminder, you can contact the Suicide and Crisis lifeline by dialing 988. If you’re a veteran, press 1.
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