VA Suicide Prevention 2.0 Program - Community Opinion Survey

OMB Control Number:  2900-XXXX

Estimated Burden:  15 minutes

Expiration Date:  __/__/2024

VA Suicide Prevention 2.0 (SP 2.0) Community Opinion Survey

Paperwork Reduction Act and Privacy Act Statement: This information is being collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended to complete this survey will average 15 minutes. This includes the time needed to follow instructions, gather the necessary facts, and respond to the questions. This information is being collected to evaluate the effectiveness of the investment in suicide prevention for Veterans. The results of this survey will help inform improvements in VA suicide prevention programs and determine whether the programs and policies implemented by a community have resulted in positive change in knowledge and attitudes. Any information you enter here is anonymous and will be kept private to the extent provided by law. All respondent contact information is stored separately from the survey answers. Participation in this survey is voluntary, and failure to respond will not have any impact on your entitlement to benefits.

Comments concerning the accuracy of the survey burden estimate and suggestions for reducing this burden should be sent

to: Rani A. Hoff, PhD, MPH - Director, North East Program Evaluation Center (NEPEC) – VA Office of Mental Health and Suicide Prevention (11OMHSP) at: rani.hoff@va.gov

Survey Text	Responses
1. What is you date of birth?	Calendar date
2. How do you describe yourself?	Male Female Transgender Do not identify as male, female or transgender
3. Would you describe yourself as (check ALL that apply):	White (For example, German, Irish, etc.) Hispanic, Latino or of Spanish origin (For example, Puerto Rican, Cuban, etc.) Black or African American (For example, African American, Haitian, Nigerian, etc.) Asian (For example, Chinese, Vietnamese, Asian Indian, etc.) Middle Eastern or North African (For example, Lebanese, Iranian, Egyptian, etc.) American Indian or Alaska Native (For example, Navajo Nation, Aztec, etc.) Native Hawaiian or other Pacific Islander (For example, Native Hawaiian, Samoan, Tongan, etc.) Some other race, ethnicity, or origin not already listed?
4. Have you served in the Armed Forces?	Yes No
5. Most people would willingly accept a person who is suicidal as a close friend	5-point Likert: Strongly Agree to Strongly Disagree
6. Most people believe that a person who is suicidal is dangerous	5-point Likert: Strongly Agree to Strongly Disagree
7. Most people think that a person who is suicidal is just as trustworthy as the average person	5-point Likert: Strongly Agree to Strongly Disagree
8. Most people would accept a person who has fully recovered from being suicidal as a teacher of young children in a public school	5-point Likert: Strongly Agree to Strongly Disagree
9. Most employers will not hire someone who is suicidal	5-point Likert: Strongly Agree to Strongly Disagree
10. Most people think less of a person who is suicidal	5-point Likert: Strongly Agree to Strongly Disagree
11. Most people would marry a person who is suicidal	5-point Likert: Strongly Agree to Strongly Disagree
12. Most employers will hire a person who is suicidal if he or she is qualified for the job	5-point Likert: Strongly Agree to Strongly Disagree
13. Most people believe that being suicidal is a sign of personal failure	5-point Likert: Strongly Agree to Strongly Disagree
14. Most people will not hire a person who has fully recovered from being suicidal to take care of their children, even if he or she had been well for some time	5-point Likert: Strongly Agree to Strongly Disagree
15. Most people in my community would treat a person who is suicidal just as they would treat anyone	5-point Likert: Strongly Agree to Strongly Disagree
16. Most people would be reluctant to date someone who is suicidal	5-point Likert: Strongly Agree to Strongly Disagree
17. Most people would willingly accept a person with a mental health problem as a close friend	5-point Likert: Strongly Agree to Strongly Disagree
18. Most people believe that a person with a mental health problem is dangerous	5-point Likert: Strongly Agree to Strongly Disagree
19. Most people think that a person with a mental health problem is just as trustworthy as the average person	5-point Likert: Strongly Agree to Strongly Disagree
20. Most people would accept a person who has fully recovered from a mental health problem as a teacher of young children in a public school	5-point Likert: Strongly Agree to Strongly Disagree
21. Most employers will not hire someone with a mental health problem	5-point Likert: Strongly Agree to Strongly Disagree
22. Most people think less of a person with a mental health problem	5-point Likert: Strongly Agree to Strongly Disagree
23. Most people would marry a person with a mental health problem	5-point Likert: Strongly Agree to Strongly Disagree
24. Most employers will hire a person with a mental health problem if he or she is qualified for the job	5-point Likert: Strongly Agree to Strongly Disagree
25. Most people believe that having a mental health problem is a sign of personal failure	5-point Likert: Strongly Agree to Strongly Disagree
26. Most people will not hire a person who has fully recovered from a mental health problem to take care of their children, even if he or she had been well for some time	5-point Likert: Strongly Agree to Strongly Disagree
27. Most people in my community would treat a person with a mental health problem just as they would treat anyone	5-point Likert: Strongly Agree to Strongly Disagree
28. Most people would be reluctant to date someone with a mental health problem	5-point Likert: Strongly Agree to Strongly Disagree
29. Most people would willingly accept a Veteran as a close friend	5-point Likert: Strongly Agree to Strongly Disagree
30. Most people believe that a Veteran is dangerous	5-point Likert: Strongly Agree to Strongly Disagree
31. Most people think that a Veteran is just as trustworthy as the average person	5-point Likert: Strongly Agree to Strongly Disagree
32. Most people would accept a Veteran as a teacher of young children in a public school	5-point Likert: Strongly Agree to Strongly Disagree
33. Most employers will not hire a Veteran	5-point Likert: Strongly Agree to Strongly Disagree
34. Most people think less of a Veteran	5-point Likert: Strongly Agree to Strongly Disagree
35. Most people would marry a Veteran	5-point Likert: Strongly Agree to Strongly Disagree
36. Most employers will hire a Veteran if he or she is qualified for the job	5-point Likert: Strongly Agree to Strongly Disagree
37. Most people believe that being a Veteran is a sign of personal failure	5-point Likert: Strongly Agree to Strongly Disagree
38. Most people will not hire a Veteran to take care of their children	5-point Likert: Strongly Agree to Strongly Disagree
39. Most people in my community would treat a Veteran just as they would treat anyone	5-point Likert: Strongly Agree to Strongly Disagree
40. Most people would be reluctant to date someone who is a Veteran	5-point Likert: Strongly Agree to Strongly Disagree
41. If you were experiencing suicidal thoughts, how likely is it that you would seek help from primary care provider (e.g., physician, nurse)	5-point Likert: Very Likely to Not Very Likely
42. If you were experiencing suicidal thoughts, how likely is it that you would seek help from a mental health professional (e.g., psychologist, social worker, counselor, psychiatrist)	5-point Likert: Very Likely to Not Very Likely
43. If you were experiencing suicidal thoughts, how likely is it that you would seek help from friends	5-point Likert: Very Likely to Not Very Likely
44. If you were experiencing suicidal thoughts, how likely is it that you would seek help from family	5-point Likert: Very Likely to Not Very Likely
45. If you were experiencing suicidal thoughts, how likely is it that you would seek help from the faith-based community (e.g., clergy)	5-point Likert: Very Likely to Not Very Likely
46. If you were experiencing suicidal thoughts, how likely is it that you would seek help from complementary and alternative medicine practitioners (e.g., acupressure, acupuncture, yoga, energy healers)	5-point Likert: Very Likely to Not Very Likely
47. If you were experiencing suicidal thoughts, how likely is it that you would seek help from National Suicide Prevention Line	5-point Likert: Very Likely to Not Very Likely
48. If someone you knew were experiencing suicidal thoughts, how likely would you be able to talk to them about seeking help for their suicidal thoughts	5-point Likert: Very Likely to Not Very Likely
49. If someone you knew were experiencing suicidal thoughts, how likely would you be able to talk to them about safe storage of their guns, such as storing them locked and unloaded	5-point Likert: Very Likely to Not Very Likely
50. In the past 12 months have you suggested to anyone that they seek help, such as from psychotherapy or counseling, for a mental health, psychological, or emotional problem	Yes No
51. In the last seven days, do you recall seeing or reading about <general unaided topic> on TV, the radio, the Internet, or some other media source.	Yes No Topic tailored to specific community
52. In the last seven days, do you recall seeing or reading <specific aided media message> on TV, the radio, the Internet, or some other media source.	Yes No Topic tailored to specific community
53. In general, how would you rate your physical health?	5-point Likert: Excellent to Poor
54. In general, how would you rate your mental health, including your mood and your ability to think?	5-point Likert: Excellent to Poor
55. Have you heard of anyone who has died by suicide in your community (i.e., the area that you live in and the people you encounter there on a regular basis)?	Yes No
56. Have you ever known anyone who died by suicide?	Yes No
56a. (If yes to 56) Was anyone you knew who died by suicide a family member?	Yes No Unsure
56b. (If yes to 56) What was your closest relationship to anyone you knew who died by suicide?	5-point Likert: Very Close to Not close at all
56c. (If yes to 56) For the person you were closest to who died by suicide, how much of an effect did this person’s suicide have on your life?	5-point Likert: 1-It had a devastating effect on me that I still feel 2-It had a devastating effect on me but I no longer feel that way 3-It disrupted my life for a short time 4-It had somewhat of an effect on me, but did not disrupt my life 5-It had little effect on my life
57. Do you have access to firearms in your home?	Yes No Not sure
58. To what extent are the firearm(s) in your home stored in a gun safe, locked cabinet, gun rack, or stored with a trigger lock?	5-point Likert: Very Often to Not Very Often One response choice for Not Applicable
59. To what extent are the firearm(s) in your home stored in an unloaded or loaded state?	5-point Likert: Very Often to Not Very Often One response choice for Not Applicable
60. Do you have access to quantities of prescribed or unprescribed medications or drugs in your home that could be life-threatening to ingest?	Yes No Not sure
61. To what extent are the medication(s) in your home stored in a locked cabinet or storage device?	5-point Likert: Very Often to Not Very Often One response choice for Not Applicable
62. Have any of your health care providers ever talked with you about your firearms or access to firearms?	Yes No Not sure
63. Have any of your health care providers ever talked with you about safe storage of medications or removing excess medications from your home?	Yes No Not sure
How much do you agree with the following statements?
64. Having a firearm in the home increases the risk of dying by suicide.	5-point Likert: Strongly Agree to Strongly Disagree
65. Keeping firearms locked and unloaded can reduce the risk of dying by suicide.	5-point Likert: Strongly Agree to Strongly Disagree
66. Temporary removal of firearms from the home, such as legal offsite storage, can reduce the risk of dying by suicide.	5-point Likert: Strongly Agree to Strongly Disagree
67. Having excess or left-over medications in the home increases the risk of dying by suicide.	5-point Likert: Strongly Agree to Strongly Disagree
68. Locking or securely storing excess or left-over medications in the home can reduce the risk of dying by suicide.	5-point Likert: Strongly Agree to Strongly Disagree
69. Removing excess or left-over medications from the home, can reduce the risk of dying by suicide.	5-point Likert: Strongly Agree to Strongly Disagree
The next few items ask about your community. When thinking about your community, you should think of the area that you live in and the people you encounter there on a regular basis. Please indicate how much you agree with each of the following:
70. This is a close-knit community.	5-point Likert: Strongly Agree to Strongly Disagree
71. People in this community are willing to help each other.	5-point Likert: Strongly Agree to Strongly Disagree
72. People in this community do not share the same values.	5-point Likert: Strongly Agree to Strongly Disagree
73. People in this community can be trusted.	5-point Likert: Strongly Agree to Strongly Disagree
74. People in this community generally don't get along with other.	5-point Likert: Strongly Agree to Strongly Disagree