Date of Conferral

2019

Degree

Ph.D.

School

Public Health

Advisor

James Rohrer

Abstract

Due to rising veteran suicide rates, the veteran population has become a focus of practitioners, research scientists, and policymakers. Although researchers have studied the relationship between suicidality and the environment, more research is required to evaluate how suicidal behavior, suicidal ideation, and suicide risk are associated with a veteran's use of medical care services within the Veterans Health Administration (VHA). Therefore, this study focused on environmental variables (medical care usage and rurality), and their relationship with suicidal behavior (Manuscript 1), suicidal ideation (Manuscript 2), and suicide risk (Manuscript 3). The social ecological model was used to better understand the interaction between the environmental factors discussed and veteran suicidality. Use of primary care services was found to be significantly associated (negative association at all levels in comparison to the reference level of high use) with each dependent variable: suicidal behavior (p < .001, OR = .074 - .529), suicidal ideation (p < .001, OR = .170 - .490), and suicide risk (p < .001, OR = .154 - .656). Finally, rurality was found to be significantly associated with suicidal behavior and suicidal ideation. A positive association was found between suicidal behavior (p < .05, OR = 8.099) and suicidal ideation (p < .05, OR = 1.892) and urban residence (in comparison to the reference level of highly rural). This study can promote social change by providing insights on how environmental factors influence veterans' propensity to suicide and by leading VHA researchers into further exploring the impact of veterans' use of services on the suicidality of the population.

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