“As a Woman, You Have to be Twice As Vocal and Twice As Obnoxious In Order to Get Anything Accomplished”: Women Veterans’ Experiences with and Recommendations to Improve VA Suicide Prevention

Background and Purpose:
Women Veterans experience distinct clinical and social risk factors for suicidal ideation compared to men, including gender-based violence, military sexual trauma, and post-service discrimination. Although the U.S. Department of Veterans Affairs (VA) has expanded suicide prevention initiatives, women Veterans remain less likely to engage in or sustain VA care, often citing prior negative experiences. Sustained engagement in care is a well-established protective factor against suicide. Prior qualitative research with VA Suicide Prevention Coordinators identified recommendations to better support women Veterans, including tailored outreach and environmental modifications. However, limited research has centered women Veterans’ own perspectives. This study examined women Veterans’ experiences with VA suicide prevention services and elicited their recommendations to improve care delivery, access, and continuity.

Methods:
We conducted semi-structured qualitative interviews between July 2024 and March 2025 with 21 women Veterans enrolled in VA care who had received a Category 1 Patient Record Flag for suicide risk within the past five years. Participants were recruited through VA clinical records and purposive sampling to ensure recent experience with suicide prevention services. Interviews explored experiences with crisis response, follow-up care, care environments, barriers to engagement, and recommendations for improvement. Interviews were audio-recorded, professionally transcribed, and analyzed using thematic content analysis. A team-based coding approach was employed to enhance rigor, and transcripts were managed using Atlas.ti 24 software. Themes were identified through iterative review and consensus.

Results:
Participants reported that acute crisis response services were generally timely and perceived as lifesaving. However, substantial barriers emerged during post-crisis follow-up care. Women described prolonged wait times for outpatient mental health services, disruptions due to provider turnover, and limited continuity of care. Many reported a lack of gender-specific services, including women-only therapy groups, inpatient units, and safe physical spaces, which hindered sustained engagement. Participants also described inadequate outreach regarding available suicide prevention and peer support resources, contributing to isolation. Experiences of gender-based violence, harassment, and discrimination during military service were frequently cited as antecedents to suicidal ideation and as factors shaping mistrust of VA systems. Women emphasized the need for gender-responsive programming, improved staffing stability, enhanced privacy and safety accommodations, and proactive outreach tailored to women Veterans.

Conclusions and Implications:
Findings indicate that while VA crisis intervention is perceived as responsive, gaps in continuity, gender-responsive services, and care environments undermine ongoing engagement among women Veterans at elevated suicide risk. Enhancing staffing stability, expanding women-specific programming, modifying physical spaces to promote safety and privacy, and strengthening targeted outreach may improve sustained care engagement. Centering women Veterans’ perspectives is critical to informing suicide prevention policies and practices that equitably address their needs.