Gender Differences in Veterans' Use of the Veterans Crisis Line: Highlighting Unique Needs of Women Veterans

Background and Purpose: Suicide is a public health crisis with particular risks among the United States (U.S.) military veteran population. Women veterans represent a unique and growing population whose unique needs are often obscured. To address suicide prevention needs of veterans, the U.S. Department of Veterans Affairs (VA) launched the VA National Suicide Prevention Hotline in 2007, renamed the Veterans Crisis Line (VCL) in 2010. The purpose of this study was to understand the gender-specific VCL use patterns, with a focus on identifying the VCL use and needs of women veterans.

Methods: Call record data collected in a VCL administrative database was reviewed for all calls by veterans calling on their own behalf with gender identified between January 1, 2018-December 31, 2019. We compared data on calls from women (n=116,029) and men (n=651,239) on: a) call time characteristics, b) reason for call frequency and rank, c) suicide risk screening and risk assessment, and d) referral outcomes. The VCL data were limited to gender categories of “male” or “female,” precluding analysis based on other gender identities.

Results: Distribution of time (hour/day/season) of VCL calls was similar between women and men callers. Among both groups, mental health was the most common reason for call listed, but women veterans were more likely than men veterans to have this reason indicated (61.7% vs. 51.4%; PR=1.19, 95% CI=1.18, 1.20). Suicidal thoughts or crisis was indicated as a reason for call among 20.1% of calls by women and 17.5% of calls by men. The most salient differences in reason for call were observed among the categories related to interpersonal violence – women were far more likely than men to express concerns related to sexual violence, either during military service (PR=9.13, 95% CI=8.83, 9.46) or non-military sexual assault (PR=5.25, 95% CI=5.01, 5.50). Calls by men were more likely than calls by women to indicate concerns related to substance use or addition as a reason for call (PR=0.54, 95% CI=0.52, 0.55). Women callers were more likely than men callers to screen positive for suicide risk (52.6% vs. 40.7%; 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 care (PR=1.09, 95% CI=1.09, 1.11).

Conclusions and Implications: Findings of a wide array of reasons for call to VCL by both women and men Veteran callers underscore the function of this resource for addressing a broad array of concerns and the need to ensure that the service adequately connects callers to a variety of information and services. Reasons for call that are not specific to suicidal crises, including interpersonal violence, economic concern, and mental health, may lead to suicidal ideation and behavior, providing an opportunity for upstream intervention at the point of hotline call. Although findings reveal similarities in call characteristics between women and men veteran callers, the differences identified also further highlight interpersonal relationships, and experiences of abuse and assault, as key contributors of crisis for women veterans.