Community Interventions to Prevent Veteran Suicide The Role of Social Determinants: Proceedings of a Virtual Symposium (2022) / Chapter Skim
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4 Social, Cultural, and Economic Determinants Related to Suicide, Panel 3
4 Social, Cultural, and Economic Determinants Related to Suicide, Panel 3
Pages 29-38
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From page 29... ...
Louis) spoke on the social determinants of suicide that impact Black American men, focusing in particular on factors that contrib ute to "provider role strain" that, in turn, can be a factor for suicide risk.
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populations within the veteran population, focusing on the health equity implications for LGBTQ+ people as seen in suicide prevention. He opened his presentation by highlighting some common terms of gender identity, pointing to the United States Transgender Survey, which shows many "evolving terms" related to gender identity in the United States.
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coding to help identify a subset of veterans "who we would think are transgender." This study revealed that while suicide was the tenth leading cause of death for cisgender veterans in the United States, it was the fourth for transgender veterans. Similarly, the rate of suicide was the fifth leading cause of death for LGB veterans, compared with the tenth leading cause for non-LGB veterans and also the U.S.
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, the lower prevalence of this particular determinant was "a good sign," Blosnich observed, and wondered if "less access to firearms could be a protective feature that we just do not really fully understand yet in this population." Access to firearms is still a signifi cant factor in suicide deaths for transgender veterans, he continued, but less so for this group than for the cisgender veteran population. At the same time, the rate of suicide death by poisoning is much higher for transgender veterans than their cisgender peers.
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From page 33... ...
because we do not include sexual orientation and gender identity in administrative datasets like we do for other populations." He noted that this affects even community-based interventions and urged making administrative datasets inclusive. The discussion at the end of this panel briefly returned to the absence of mortality data for sexual and gender minority veterans; there, Blosnich said, to rectify this, "we are currently trying to train death investigators to gather information about sexual orientation and gender identity;" he also said that while the National Violent Death Reporting System at the CDC does have fields for sexual orientation and gender identity, these fields are left blank about 80 percent of the time.
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, a report from the Congressional Black Caucus Emergency Taskforce on Black Youth Suicide and Mental Health made in an effort to draw attention to this situation. This report draws on data from trend analysis and shows that for most age groups, from 2001–2015, the rate of suicide for White Americans was higher than for Black Americans, with one exception, Joe explained; in the 12 and under age group, the rate of suicide for Black children was higher than that for White children (Bridge et al., 2018)
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, a national household probability sample of 5,181 Black respondents aged 18 years and older, conducted between February 2001 and June 2003 (Jackson et al., 2004) , Joe identified some variables to measure provider role strain that might, in turn, function as predictors for an increased risk for suicide ideation and suicide attempts among Black men.
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leave that very skilled setting of armed services." More generally, Joe said, "this combination of factors" that contribute to provider role strain and also are present in the moment of veterans' transition out of active duty "must be considered for any community-level suicide prevention strategy particularly for Black Americans." DISCUSSION The discussion, moderated by Ramchand, covered questions of data, the impact of military culture on expectations for Black males, discrimination as a social determinant, and why Black American children seem to be at increasingly higher risk for suicide. Joe addressed the possibility that hyper masculine military culture might intensify self-perceived expectations about what the role of a man should for Black men more than White men; he commented, "I would expect to see a hardening of the adherence to .
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"There has been a change in cultural expectations between the generations," and so now we are seeing a corresponding increase in rates of suicide morbidity, Joe suggested. He added that some protective factors have waned "or are no longer as protective." As Black individuals become subject to cultural expectations around individual achievement and the American Dream -- "I should be able to achieve as much as everyone else" -- Joe said, they may encounter obstacles that are not the result of indi vidual factors but social determinants, but not see these obstacles as such.
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