Military Service Members at Elevated Suicide Risk
Conditions
Keywords
suicide prevention, reducing stigma
Brief summary
There is sufficient evidence that military service members markedly underutilize behavioral health care services, in part, due to stigma. This study proposes to examine a novel application of a cognitive bias modification (CBM) intervention designed to target stigma-related cognitions among service members at elevated suicide risk not currently engaged in behavioral health treatment.
Detailed description
This study proposes to examine a novel application of a cognitive bias modification (CBM) intervention designed to target stigma-related cognitions among service members at elevated suicide risk not currently engaged in behavioral health treatment. Interventions that leverage CBM principles involve the completion of brief, web-based tasks in which participants are presented with a series of stimuli (e.g., words, sentences) and trained to respond to those stimuli in a manner that is positive or neutral, rather than negative and unhelpful. Consistent with the theoretical rationale for Cognitive Behavioral Therapy, CBM interventions function by reshaping negative cognitions. Repeated reinforcement of adaptive cognitions enhances functioning and reduces distress. CBM interventions have efficacy in reducing maladaptive cognitions across a range of psychiatric symptoms. However, limited data exist regarding the use of CBM to target help-seeking stigma cognitions.
Interventions
BEHAVIORALCognitive Bias Modification Intervention for Help-Seeking Stigma
Cognitive bias modification (CBM) is an intervention designed to target stigma-related cognitions among individuals at elevated suicide risk not currently engaged in behavioral health treatment. It involves the completion of brief, web-based tasks in which participants are presented with a series of stimuli (e.g., words, sentences) and trained to respond to those stimuli in a manner that is positive or neutral, rather than negative and unhelpful. Consistent with the theoretical rationale for Cognitive Behavioral Therapy, CBM interventions function by reshaping negative cognitions. Repeated reinforcement of adaptive cognitions enhances functioning and reduces distress.
BEHAVIORALPlacebo Cognitive Bias Modification (CBM-Placebo)
Cognitive bias modification (CBM) is an intervention designed to target stigma-related cognitions among individuals at elevated suicide risk not currently engaged in behavioral health treatment. It involves the completion of brief, web-based tasks in which participants are presented with a series of stimuli (e.g., words, sentences) and trained to respond to those stimuli in a manner that is positive or neutral, rather than negative and unhelpful. Consistent with the theoretical rationale for Cognitive Behavioral Therapy, CBM interventions function by reshaping negative cognitions. Repeated reinforcement of adaptive cognitions enhances functioning and reduces distress.
BEHAVIORALSelf-Directed Psychoeducation
Material presented with information on mental health literacy, mental health stigma, & treatment options. This is based on the idea that increasing knowledge about psychiatric symptoms and treatment options encourages help-seeking behavior and engagement.
Sponsors
Military Suicide Research Consortium
Florida State University
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Subject)
Masking description
Participant will be in the Cognitive Bias Modification Intervention for Help-Seeking Stigma (CBM-HS) condition (intervention condition), the Cognitive Bias Modification (CBM-Placebo) condition (placebo condition), or the Self-Directed Psychoeducation condition (comparison condition).
Intervention model description
Participants will be placed in one of three groups (Cognitive Bias Modification Intervention for Help-Seeking Stigma (CBM-HS) condition, the Cognitive Bias Modification (CBM-Placebo) condition, or the Self-Directed Psychoeducation condition \[comparison condition\]). Participants will then complete 5 additional virtual study visits (3 intervention weeks, 1 post-treatment, 1 two-month follow-up); these study visits will occur through a web-based platform. Self-report measures will be administered at enrollment/baseline, mid-intervention, post-intervention, and two-month follow-up.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* current active duty U.S. military service member * lifetime history of suicidal ideation per a self-report version of the SITBI-SF and/or * current elevated suicide risk factors (i.e., screening positive for clinically significant suicidal ideation \[DSI-SS Total Score \> 2\], depression \[PHQ-9 Total Score \> 14\], anxiety \[GAD-7 Total Score \> 9\], PTSD \[PCL-5 Total Score \> 32\], alcohol use \[AUDIT-C Total Score \> 3 for men and \> 2 for women\], and/or anger \[DARS Total Score \> 22\]) * no current behavioral health service use (i.e., ongoing care with a provider to receive psychiatric medications, therapy, and/or counseling)
Exclusion criteria
* unable to provide informed consent * lack of Internet access via a computer, tablet, and/or mobile phone * scheduled to be stationed outside the continental U.S. any time during the 11 weeks following study enrollment (i.e., during the study period) * imminent suicide risk (i.e., suicide risk warranting hospitalization) based on the Joiner et al. and Chu et al. Decision Tree Framework.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Perceived Stigma and Barriers to Care for Psychological Problems Scale (PS) | 2-Month Follow-up | The 11-item PS measures the extent to which various concerns might affect an individual's decision to seek psychiatric treatment. Items are rated on a 5-point scale; higher scores (range: 11-55) indicate greater perceived barriers to care. The PS has been used extensively in military populations and has exhibited acceptable to good internal consistency. |
| Readiness to Change | 2-Month Follow-up | Consistent with past research, we will use an adaptation of the Readiness to Change Scale to assess readiness to engage in help-seeking behaviors. Responses to each of the 6 items are anchored on an 11-point scale, with higher scores (range: 0-60) indicating greater readiness to engage in behavioral health care. Past research using this approach has yielded good internal consistency. |
| Self-Stigma of Seeking Help (SSOSH) | 2-Month Follow-up | The SSOSH is a 10-item measure of help-seeking stigma. Responses are rated on a 5-point scale; higher scores (range: 0-50) reflect greater self-stigma associated with seeking help. The scale has demonstrated strong reliability and validity, and it differentiates between young adults who do and do not seek help for mental health problems. |
| World Mental Health Composite International Diagnostic Interview (WMH-CIDI) | 2-Month Follow-up | A self-report version of the WMH-CIDI Services subscale will be utilized to assess the presence/absence of specific structural and attitudinal barriers to care. This WMH-CIDI has been used extensively among adult community samples, including among individuals at elevated suicide risk. |
| Client Satisfaction Questionnaire-8 (CSQ-8) | 2-Month Follow-up | The CSQ-8 is an 8-item self-report measure that assesses client satisfaction with services, including mental health care services (range: 8-32). The CSQ-8 has demonstrated strong psychometric properties, including among psychotherapy patients. |
| Intervention Acceptability and Feasibility Questionnaire | 2-Month Follow-up | Acceptability and feasibility will be measured using recruitment and retention rates and open-ended treatment satisfaction questions administered to participants at post-treatment (e.g., What aspects of the intervention could be improved?). |
Countries
United States
Outcome results
None listed