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Background Appropriate after-care for the estimated 1.4 million people with nonfatal suicide attempts each year in the United States is critical, yet little research has focused on recovery needs after an attempt and whether important gender differences in those needs may exist. In this study, we examined gender differences in recovery needs after a suicide attempt among a national sample of women and men veterans. Methods We interviewed 25 women and 25 men veterans from Veterans Health Administration health care systems across the country. Purposive sampling was used to obtain a demographically and clinically diverse sample. Transcripts were analyzed using thematic analysis. Results Although some recovery topics were similar between genders, the participants' primary recovery needs, or goals, differed by gender. Women focused on developing connections with others and wanted to increase their self-knowledge and self-worth. Men were focused on trying to live up to their ideal selves by living and doing "right." Men also wanted to feel like they were needed by others. Both women and men also wanted to feel a stronger sense of purpose in their lives. Conclusions Findings suggest that recovery needs among veterans after a nonfatal suicide attempt vary by gender: women may benefit more from psychoeducational approaches in group settings with other women, whereas men may benefit more from approaches that help them focus on making changes in their lives towards becoming their ideal selves.

Background Understanding the nature of suicidal ideation, or how suicidal ideation is experienced by the individual in its course and development, is important for informing suicidal ideation assessment and treatment. In this study, we conducted qualitative interviews with a national sample of fifty United States (U.S.) military veterans with recent suicide attempts to elucidate the nature of suicidal ideation from the perspective of those with lived experience. Methods We interviewed 25 women and 25 men veterans from Veterans Health Administration healthcare facilities across the U.S. who made a recent (prior 6 months) suicide attempt. Data were analyzed using a thematic analysis approach. Results Suicidal ideation was characterized as chronic, varying in severity and duration. Two typologies characterized increases in suicidal ideation severity: those whose ideation increases due to negative self-evaluations and those whose ideation increases without clear warning. Additionally, participants described needing help recovering from severe episodes of suicidal ideation, which often disrupted their lives and everyday functioning. Limitations This was a study of U.S. military Veterans with a recent suicide attempt; our findings may differ from studies of nonveterans or those with suicidal ideation but have never attempted suicide. Conclusions Our findings align with prior research that suicidal ideation is often experienced as chronic, fluctuating, and nonlinear. Suicide risk assessment may benefit from use of a combination of ideation severity and functional measures. Future work should investigate treatment of suicidal ideation that targets active symptom management and ameliorates the negative impacts that suicidal ideation has on patients’ functioning.

Rationale: The rate of suicide mortality among women is increasing in the United States (U.S.), especially among military veterans. Prior research suggests that important gender differences in suicide risk exist, but not enough is known to tailor prevention approaches by gender. Objective: The goal of this study is to understand gender differences in the development of suicidal behaviors (suicide risk) among U.S. veterans to inform future research and gender-tailored prevention efforts. Methods: Using a modified grounded theory approach, this qualitative study interviewed 50 (25 men, 25 women) U.S. veterans who had made a recent (prior 6 months) suicide attempt. Veterans were recruited from Veterans Health Administration (VHA) healthcare facilities across the U.S. Semi-structured, hour-long interviews examined participants' experiences with military service, suicidal thoughts and attempts, and healthcare following their attempt. Results: The analysis revealed two gendered narratives of suicidal thoughts and attempts that incorporated the primary themes of self-concept, social power, relationships, coping, and stress. When discussing reasons for their suicide attempts, women discussed negative self-evaluative processes describing themselves as, “shameful,” “tainted,” and “worthless,” whereas men discussed becoming overwhelmed, and recalled thinking, “it just wasn't worth it,” “I've had enough,” and, “screw this.” Conclusions: This study provides an in-depth, nuanced understanding of the gender differences in suicide risk among veterans and suggests several ways in which future work may address gender-tailored suicide prevention efforts. Specifically, women veterans may benefit from methods to increase self-worth through positive social relationships, while men veterans may benefit from methods that increase their sense of purpose in life and help them achieve their ideal selves through successful experiences.