Community Interventions to Prevent Veteran Suicide The Role of Social Determinants: Proceedings of a Virtual Symposium (2022) / Chapter Skim
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3 Social, Cultural, and Economic Determinants Related to Suicide, Panel 2
3 Social, Cultural, and Economic Determinants Related to Suicide, Panel 2
Pages 15-28
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addressed social determinants of health and risk factors as related to suicide rates among women veterans. VETERANS IN RURAL AREAS A variety of factors more prevalent in rural communities than in urban ones may be contributing to much higher rates of suicide in the former, Mohatt said.
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to greater burden or greater problems from the same levels of diagnoses that exist in urban areas." Finally, he noted, geographic isolation in rural communities can lead to greater social isolation, which disproportionately impacts vulnerable populations. One such population is older adults who can no longer drive; similarly, people with disabilities and people with mental illness challenges can "become increasingly more socially isolated." Suicide rates are increasing more quickly in rural areas than urban communities, Mohatt said, and "this disparity has been widening over the past 30 years." Rural veterans have a 14 percent to 20 percent increased risk of death by suicide compared with urban veterans, he said.
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These trends all contribute to the disparity between rural and urban rates of suicide among veterans: higher proportions of White and Native American veterans, and a faster rate among rural Hispanic veterans. Mohatt noted that while understanding risks for suicide among rural White populations is an important part of "understanding rural suicide in the United States," attributing higher suicide rates in rural America to a proportionately higher White population in those areas is oversimplifying the problem and "doesn't help us understand why there are higher suicide rates in rural places where there aren't White Americans with guns." Rates of suicide are higher in rural communities not just in the United States but internationally; international literature can help identify factors beyond race that contribute to this disparity between rural and urban suicide rates, he said.
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Fourth, he noted that the review found that financial and economic factors do not contribute more to suicide risk in rural communities than in urban ones, and so do not explain the disparity between the two; but they do contribute to rural suicide. In addition to these factors that increase risk of suicide, Mohatt noted, rural areas also possess strengths that can possibly be leveraged to decrease risk of suicide.
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End of Horn's presentation focused on the social determinants of health, and suicide as alongside other health outcomes, among Native populations. She began by describing social determinants that affect the population as a whole and then turned to how these factors particularly impact the Native veteran population.
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one of the more core groups on the reservation that are willing to do a lot more for specifically elderly and for children." The mortality rates among Natives are an important factor in understanding the situation for Native veterans in particular, End of Horn said. The average age of death is 78 years old, which is lower than the nonHispanic White population; additionally, "they are suffering from a high rate of morbidity," she noted.
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Additionally, risk of suicidal ideation is twice as high for Native veterans as for non-Hispanic White veterans, she said. End of Horn concluded her presentation with a discussion of some strategies for meeting the needs of Native veterans.
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Paul, Minnesota, as a contributor to good outcomes at that institution. "The traditional healer within the community often bridged the gap for Native veterans to get into services and result in actually coming and getting care." End of Horn emphasized that in this situation, participation in traditional practices often served to connect Native veterans with the VA.
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She began by reminding listeners that gender itself is a social determinant of health; additionally, "we should expect that other social determinants of health impact outcomes differentially by gender as well." She sketched an overview of women in the military, women veterans, and suicide rates compared with male veterans. Following this, Hoffmire discussed three studies that showed fluctuations in the risk for suicide and instances of suicidal ideation over the life course.
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Turning to a consideration of the social determinants of suicide risk for women veterans, Hoffmire summarized, "We know that gender is clearly a determinate of suicide risk among our veterans." For women in particular, she noted that data are scarce but "increasingly available." Hoffmire stated, "delineating specific factors, including social determinants of health, driving suicide risk for women veterans, overall and at specific times across the life course, is essential." She said that one growing area of research is psychosocial stressors and differences of their impact by gender. Hoffmire briefly reviewed such stressors, including the following: • Housing and financial concerns.
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This aversion might be the result of many factors, Hoffmire noted, citing "institutional betrayal" as one possibility. "Certainly we can address suicide risk for our women veterans by looking at and addressing social determinants of health" including these psychosocial stressors as they particularly impact women, Hoffmire summarized.
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Hoffmire concluded her presentation by gesturing to several ongoing studies that will expand knowledge regarding social determinants of suicide risk for women veterans, including consideration of the impact that COVID-19 might have on the risk for suicide among this population. DISCUSSION Discussion for this panel was moderated by Lewis and began with a consideration of the impact of an increase in rural populations due to relocation from urban centers spurred by the COVID-19 pandemic.
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She reiterated the importance of having representation within the VA system, not just for Native populations but for other religious affiliations. She also noted that Native veterans come to the IHS over the VA in part because "we're right there" on the reservation, making access easier.
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