Serving All Who Have Served: Enhancing Suicide-Related Care Quality for Black, Indigenous, and People of Color Veterans

Background: Veteran suicide prevention remains the top clinical priority for the Veterans Health Administration
(VHA). To mitigate Veteran suicide risk, VHA has national guidelines recommending an enhanced care package
after self-directed violence (SDV) such as creating a suicide safety plan or increasing the frequency of outpatient
mental health visits. Adherence to each given care component is considered a marker of care quality for suicide
risk (henceforth referred to as suicide-related care quality). Recent research utilizing national VHA data
suggests these care components may not be provided equitably to all Veterans. As research shows that Black,
Indigenous, and People of Color (BIPOC) Veterans experience poorer mental health care quality than white
Veterans, it is possible that similar issues may impact their suicide-related care quality. However, no research to
date has examined the quality of suicide-related care among BIPOC Veterans. Thus, further evaluation of
suicide-related care quality is needed to ensure equitable, effective care for BIPOC Veterans with SDV. The
current proposal seeks to evaluate components of suicide-related care quality among BIPOC Veterans using a
concurrent, mixed-methods triangulation approach to inform future intervention development.
Significance: The proposed project directly addresses VHA’s top clinical priority, suicide prevention. In
addition, this proposal aligns with VA HSR&D’s high priority foci of suicide prevention and health equity as well
as VHA National Strategic Plan Objectives 2.1 and 2.3 which focus on ensuring Veterans receive equitable,
comprehensive suicide prevention services to support their recovery. VHA Office of Health Equity and VHA
Office of Mental Health and Suicide Prevention also highlight in their strategic plans the need for supporting
equitable, suicide-related care for all Veterans.
Innovation and Impact: The proposed project is the first evaluation of suicide-related care quality among BIPOC
Veterans with SDV. In addition, no research to date has determined areas to improve suicide-related care quality
for BIPOC Veterans. Use of national VHA- and non-VHA administrative data triangulated with BIPOC Veteran
and mental health clinician qualitative data will result in a richer conceptualization of current factors impacting
suicide-related care and inform future strategies for enhancing care.
Specific Aims: Aim 1) Evaluate suicide-related care quality among BIPOC Veterans; Aim 2) Conduct qualitative
interviews with BIPOC Veterans and VA clinicians to better understand factors impacting suicide-related care
quality for BIPOC Veterans; Aim 3) Explore associations between health care systems-level factors and suicide-
related care quality indicators for BIPOC Veterans; Exploratory Aim) Explore the relationship between suicide-
related care quality among BIPOC Veterans and suicide outcomes.
Methodology: Aim 1 will identify BIPOC Veterans with SDV (FY18-FY22) utilizing VHA databases. Data from
the VHA Corporate Data Warehouse for suicide-related care quality outcomes as well as sociodemographic and
clinical variables will be linked. Data will be analyzed using generalized estimating equations. Aim 2 will involve
interviews with at least 40 BIPOC Veterans and at least 40 VHA mental health clinicians about their beliefs and
experiences with suicide-related care which will be analyzed using thematic analysis. Aim 3 will link data from
Aim 1 to health care systems factors at the station level. For the Exploratory Aim will link data from mortality data
sources to explore associations with mortality outcomes.
Next Steps/ Implementation: The proposed project will increase our understanding of factors impacting suicide-
related care quality among BIPOC Veterans. Findings from this project will inform future proposals focused on
intervention development to enhance suicide-related care quality among BIPOC Veterans.

Grant Number: 5I01HX003545-03
NIH Institute/Center: VA
Principal Investigator: Jason Chen