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Abstract
OBJECTIVE The mental health impacts of the COVID-19 pandemic have been widely felt among already vulnerable populations, such as U.S. military veterans, including a heightened risk for depression and suicidal ideation. Support hotlines such as the Veterans Crisis Line (VCL) took a central role in addressing various concerns from callers in distress; research has yet to examine the concerns of veterans who used the VCL during the early months of the pandemic. METHODS A mixed-methods analysis of characteristics of veteran outreach to the VCL during the first year of the COVID-19 pandemic in the United States was conducted on 342,248 calls during April-December 2020; 3.8% (N=12,869) of calls were coded as related to COVID-19. Quantitative examination was conducted regarding COVID-19-related reasons for contact, suicide risk screens, and caller concerns; 360 unique calls with synopsis notes that included a COVID-19 flag were qualitatively analyzed. RESULTS Quantitative analysis of the calls with a COVID-19 flag revealed mental health concerns, loneliness, and suicidal thoughts as top reasons veterans contacted the VCL during the pandemic. Qualitative analysis identified specific economic and mental health concerns, including negative impacts on income and housing, increased feelings of depression or anxiety, and pandemic-specific concerns such as testing and vaccine availability. Disrupted access to resources for coping, including support groups or gyms, had negative perceived impacts and sometimes exacerbated preexisting problems such as substance abuse or depression. CONCLUSIONS These findings emphasize the role of VCL as providing general support to veterans experiencing loneliness and supplying assistance in coping with pandemic-related distress.
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Affiliation(s)
- Lauren Sealy Krishnamurti
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh (Krishnamurti); Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia (Agha, Dichter); Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, School of Medicine, Boston University, Boston (Iverson); Department of Psychiatry, University of Colorado Anschutz Medical Campus, and Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, VA, Denver (Monteith); School of Social Work, Temple University, Philadelphia (Dichter)
| | - Aneeza Agha
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh (Krishnamurti); Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia (Agha, Dichter); Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, School of Medicine, Boston University, Boston (Iverson); Department of Psychiatry, University of Colorado Anschutz Medical Campus, and Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, VA, Denver (Monteith); School of Social Work, Temple University, Philadelphia (Dichter)
| | - Katherine M Iverson
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh (Krishnamurti); Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia (Agha, Dichter); Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, School of Medicine, Boston University, Boston (Iverson); Department of Psychiatry, University of Colorado Anschutz Medical Campus, and Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, VA, Denver (Monteith); School of Social Work, Temple University, Philadelphia (Dichter)
| | - Lindsey L Monteith
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh (Krishnamurti); Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia (Agha, Dichter); Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, School of Medicine, Boston University, Boston (Iverson); Department of Psychiatry, University of Colorado Anschutz Medical Campus, and Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, VA, Denver (Monteith); School of Social Work, Temple University, Philadelphia (Dichter)
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh (Krishnamurti); Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia (Agha, Dichter); Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, School of Medicine, Boston University, Boston (Iverson); Department of Psychiatry, University of Colorado Anschutz Medical Campus, and Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, VA, Denver (Monteith); School of Social Work, Temple University, Philadelphia (Dichter)
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Krishnamurti LS, Monteith LL, McCoy I, Dichter ME. Gender differences in use of suicide crisis hotlines: a scoping review of current literature. JPMH 2022. [DOI: 10.1108/jpmh-10-2021-0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Little is known about the gender profile of callers to crisis hotlines, despite distinct gender differences in suicide risk and behavior. The authors assessed current knowledge of the role of caller gender in the use of crisis hotlines for suicide, specifically whether there are differences in frequency, reason for call and caller outcomes by gender.
Design/methodology/approach
The authors conducted a scoping literature review of peer-reviewed studies published since 2000 in Medline, PubMed and PsychInfo, examining a total of 18 articles based on 16 studies.
Findings
Overall, women represent a higher percentage of calls to crisis hotlines worldwide, despite men having higher rates of suicide. Primary reasons for calling hotlines were the same for men and women, regardless of geography or culture. When gender differences in reason for call were reported, they were consistent with literature documenting gender differences in the prevalence of risk factors for suicide, including higher rates of substance use among men and higher instances of domestic violence/abuse among women.
Research limitations/implications
There was variability in the studies the authors examined. This review was limited to research on crisis telephone hotlines and did not include text or chat services. Due to data reporting, the findings are constrained to reporting on a male/female gender binary.
Originality/value
Findings on gender differences in crisis line use suggest a need for continued research in this area to determine how to best meet the needs of callers of all genders.
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Dichter ME, Krishnamurti LS, Chhatre S, Hoffmire CA, Monteith LL, Bellamy SL, Iverson KM, Montgomery AE, Agha A, McCoy I. Gender differences in veterans' use of the Veterans Crisis Line (VCL): Findings from VCL call data. Gen Hosp Psychiatry 2022; 74:65-70. [PMID: 34923376 DOI: 10.1016/j.genhosppsych.2021.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/22/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare characteristics of calls to the Veterans Crisis Line (VCL) by caller gender and identify potentially unique needs of women callers. METHOD Retrospective review of clinical data collected during VCL calls, comparing call characteristics between women and men veteran callers. RESULTS The data included 116,029 calls by women veterans and 651,239 calls by men veterans between January 1, 2018-December 31, 2019. Timing (hour/day/season) of VCL calls was similar between women and men callers. We observed gender differences in reason for call, with the most salient differences in reasons related to interpersonal violence, including sexual trauma (e.g., military sexual trauma as reason for call - prevalence ratio (PR) for women vs. men = 9.13, 95% CI = 8.83, 9.46). Women callers were also more likely than men callers to screen positive for suicide risk (PR = 1.28, 95% CI = 1.26, 1.29), receive a higher suicide risk assessment rating (PR = 1.05, 95% CI = 1.02, 1.07), and be referred to a VA Suicide Prevention Coordinator for follow-up (PR = 1.09, 95% CI = 1.09, 1.11). CONCLUSIONS Analysis of VCL call data indicated both similarities and differences across genders in call characteristics, including interpersonal relationships and experiences of abuse and assault as particularly salient factors prompting women veterans' calls to VCL. This study also suggests the presence of increased suicide risk among women versus men veteran VCL callers.
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Affiliation(s)
- Melissa E Dichter
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, USA; Temple University School of Social Work, USA.
| | - Lauren Sealy Krishnamurti
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, USA
| | - Sumedha Chhatre
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA
| | - Claire A Hoffmire
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, USA; Department of Physical Medicine and Rehabilitation, University of Anschutz Medical Campus, USA
| | - Lindsey L Monteith
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, USA; Department of Psychiatry, University of Anschutz Medical Campus, USA
| | - Scarlett L Bellamy
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, USA; Department of Epidemiology and Biostatistics, Drexel University, Dornsife School of Public Health, USA
| | - Katherine M Iverson
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, USA; Department of Psychiatry, Boston University School of Medicine, USA
| | - Ann Elizabeth Montgomery
- Birmingham VA Health Care System & National Center on Homelessness among Veterans, USA; University of Alabama at Birmingham, School of Public Health, USA
| | - Aneeza Agha
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, USA
| | - Ian McCoy
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Crescenz VA Medical Center, USA
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Spencer NE, Taubenberger SP, Roberto R, Krishnamurti LS, Chang JC, Hacker K. "Stories of starting": Understanding the complex contexts of opioid misuse initiation. Subst Abus 2021; 42:865-872. [PMID: 33617751 PMCID: PMC10947450 DOI: 10.1080/08897077.2021.1878084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: The impacts of opioid use disorder and opioid-involved overdose are known, but less is known about the contexts in which people first misuse opioids, and the motivations for continued misuse. Methods: In-depth interviews with 26 individuals in Allegheny County, Pennsylvania with current or past histories of opioid misuse were conducted. Narratives were analyzed to understand the circumstances and influences contributing to initial and continued misuse of opioids. Results: Participants described social and familial contexts that normalized or accepted opioid misuse-this often included their own use of other illicit substances prior to initiating opioids. Participants also described initial use of opioids as related to efforts to cope with physical pain. They also described recognizing and then seeking psychological/emotional benefits from opioids. All three of these themes often overlapped and intersected in these stories of starting opioid misuse. Conclusions: Opioid misuse stemmed from complex interacting influences involving coping with physical and psychological pain, perception that opioids are needed to feel "normal", and acceptance or normalization of opioid use. This suggests a multi-pronged approach to both prevention and treatment are needed.
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Affiliation(s)
- Noelle E. Spencer
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | | | - Raisa Roberto
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | | | - Judy C. Chang
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Karen Hacker
- Allegheny County (Pennsylvania) Health Department, Allegheny County, Pennsylvania, USA
- Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
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Krishnamurti LS. The Potential of "Watchful" Care: Preventing Suicide with Aloha in Hawaii. Med Anthropol Q 2020; 35:120-135. [PMID: 32812236 DOI: 10.1111/maq.12610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/23/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
As a therapeutic practice of care, "watchfulness" (Garcia 2010) implies a vigilant responsibility and constant mindfulness of others; in Hawaii, this is captured in the concept of aloha. This article explains how watchful care with aloha is discussed and mobilized in community suicide prevention in Hawaii. Rates of suicidality and suicide attempts in the state are high, among young people in particular. My ethnographic research follows a network of workers and volunteers as they incorporate local understandings of aloha into suicide prevention outreach. Following a history of aloha's meanings and (mis)uses in and beyond Hawaii, I draw on ethnographic examples to reveal how care with aloha prioritizes personal connection and individuality, rather than being rhetorically detached or "anonymous" (Stevenson 2014). But as my central vignettes reveal, there are difficulties in the implementation of this kind of watchful care, which ultimately question its utility in suicide prevention.
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