Suicide is a significant public health concern for veterans residing in rural communities. Although various initiatives have been implemented to prevent suicide among veterans, efforts specific to rural veterans remain limited. To aid such efforts, we examined stigma as a potential barrier to community readiness in the implementation of a community-based suicide prevention program for rural veterans. In this qualitative study, community readiness interviews were conducted with 13 participants in a rural community. Themes included lack of awareness regarding veteran suicide, rare discussions of veteran suicide, and suicide-related stigma within the community. Results suggest that prioritizing destigmatization may be particularly important to implementing community-based suicide prevention programming in rural communities. In particular, addressing community misconceptions regarding veteran suicide, while increasing knowledge of the extent to which veteran suicide occurs locally may facilitate increased awareness and thus community readiness to prevent suicide among rural veterans.

Objective The purpose of this study was to develop a conceptual model of community‐based veteran peer suicide prevention. Method We conducted a qualitative study in which semi‐structured interviews were followed by three focus groups. Participants (n = 17) were chosen from community‐based organizations who had peers working on veteran suicide prevention; the sample included veteran peers, non‐peers, program managers, and community stakeholders. Interview data were analyzed thematically and inductively to identify key components and subcomponents of veteran peer suicide prevention. A draft model was shared with each focus group to elicit feedback and refine key concepts. Results A conceptual model containing nine components and twenty‐six subcomponents was developed. Participants emphasized key organizational, relational, and practical elements needed to achieve positive outcomes. In addition, they described critical contextual and cultural factors that impacted veteran peers’ ability to prevent suicide and promote overall wellness. Conclusions Community‐based veteran peer efforts are a promising public health approach to preventing veteran suicide. Provided veteran peers are supported and fully allowed to contribute, these efforts can complement existing clinic‐based efforts. Future research on community‐based veteran peer suicide prevention should document a range of outcomes (e.g., clinical, wellness, financial) and allow for considerable flexibility in peer approaches.

Background There are approximately 20 million veterans living in the United States today (U.S. Department of Veterans Affairs, 2018a). The military conflicts of the Post 9/11 era, such as Operation Iraqi Freedom and Operation Enduring Freedom, increased combat operations and subsequently grew the size of the military, resulting in the largest surge of reintegrating veterans in recent history. The transition from active duty to veteran status often requires service members to move from certainty, routine, community, and a sense of purpose to uncertainty. Reintegrating veterans are vulnerable to social isolation, anxiety, depression, and exacerbations of post-traumatic stress. In comparison to their civilian peers, veterans of these Post 9/11 conflicts experience elevated rates of mental illness and suicide (U.S. Department of Veterans Affairs, 2016). However, struggles with mental health are not unique to newly reintegrating veterans alone. Veterans of prior conflicts also experience a high burden of mental illness (U.S. Department of Veterans Affairs, 2016). For example, in a 2015 assessment of Vietnam veterans, 11.2% had a diagnosis of Post-Traumatic Stress Disorder (PTSD), 36.7% had a diagnosis of major depression, and 2.2% struggled with alcohol abuse (Marmar et al., 2015). Further, in 2016, approximately 65% of all veterans who died by suicide were older than 50 years (U.S. Department of Veterans Affairs, 2016). Moreover, approximately 20 veterans of all conflicts die from suicide each day (U.S. Department of Veterans Affairs, 2018b). According to the Veterans Affairs (2017), suicide risk was 22 percent higher among veterans when compared to their civilian counterparts (after adjusting for the difference in age and sex). The United States Department of Veterans Affairs (VA), academic institutions, and healthcare and community organizations are developing strategies to address this