Mental Health, Suicide
Conditions
Keywords
communication, Veterans, public health, treatment engagement
Brief summary
The risk for suicide increases by nearly 50% in the first year that service members transition from the military to civilian life underscoring the need for effective strategies to facilitate help seeking among Veterans vulnerable to self-directed violence. Yet despite a great need for treatment, more than half of returning Veterans at risk for suicide do not initiate mental health services. VA has embarked on the regular use of communication campaigns as part of a public health approach designed to reach the larger Veteran population with messages promoting help seeking. However, what types of messages effectively change beliefs and behaviors for at-risk Veterans resistant to seek treatment is unclear. The main objective of this study is to develop and test the use of public messaging to increase treatment seeking among Veterans at risk for suicide and resistant to seek mental health care following separation from military service. This represents the first study to systematically develop public messaging strategies for populations at risk for suicide.
Detailed description
The main objective of this study is to develop and test the use of public messaging to increase treatment seeking among Veterans at risk for suicide and resistant to seek mental health care following separation from military service. A four-year mixed methods study that uses a sequential embedded design will be used to collect data from nationwide samples of Veterans at risk for suicide not in mental health treatment who separated from the DoD in the past year. Informed by the Theory of Planned Behavior, individual interviews will first be conducted to guide the design of effective public messages that will be subsequently tested in an RCT to determine exposure effects among targeted audience vs. waitlist control. Messages will be disseminated to study participants during the trial by a smartphone app. Research staff will collect assessments by telephone at baseline, 1- and 2-months post-randomization. Potential participants will primarily be identified using data available from the VA/DOD Identity Repository (VADIR) and recruited by invitational mailing and follow-up telephone calls. If the intervention is found effective, the investigators will work with the VA operational partner to include messages in future outreach approaches to prevent Veteran suicide and use findings to improve current communication performance measures.
Interventions
BEHAVIORALMessaging
Four brief video messages focused on facilitating treatment seeking. Intervention delivered to participant by study mobile app downloaded to participants' own smartphone.
OTHERWait list control
one push notification each week thanking individuals for participation, informing them that they will receive messages in the near future or reminding them of the length of the study.
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
All participants will complete the consent process and baseline assessment by telephone with an RA and are randomized to receive the intervention at either immediately following baseline (T1), at 1-month (T2) or 2-month follow up (T3). Exposure to intervention occurs over a 1-month period.
Eligibility
Sex/Gender
ALL
Age
18 Years to 89 Years
Healthy volunteers
Yes
Inclusion criteria
* U.S. Veteran that separated from military service in the past 36 months or less (any discharge type); * \>18 years old; * experiencing suicide risk; * low intent to seek help; * capable of understanding the goals of the study; * willing and able to provide verbal consent; * smartphone ownership and willing to download/use study mobile app
Exclusion criteria
* currently (or in the past 12 months) in formal mental health treatment services; * deemed impaired during eligibility screening; * currently institutionalized
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Treatment Initiation | baseline through 2-month follow-up | yes to initiating psychological treatment and/or medication/pharmacological treatment in the past month to treat mental health issues. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean Change in Beliefs About Mental Health Treatment | baseline through 2-month follow up | Beliefs about mental health treatment was assessed using the "Perceptions about Services Scale" with individuals endorsing items on a scale from 1 (lowest agreement) to 7 (higher agreement). A mean is calculated across items to create a composite score (higher score = greater positive beliefs about mental health treatment); lowest score = 1; highest score = 7. |
| Mean Change in Intentions to Seek Treatment | baseline through 2-month follow up | change in intent to seek mental health treatment in the next month measured using a 7-point likert scale (1 indicating low intent and 7 indicating strong intent) from items in the "Perceptions about Services Scale." A mean is calculated (higher score representing higher intentions) to create a composite score on the scale. lowest score = 1; highest score = 7. |
| Mean Change in Perceived Treatment Barriers | baseline through 2-month follow up | Used the "Perceived Stigma and Barriers to Care scale" to assess change in agreement with barriers to mental health care that impede one's own behaviors measured using a response scale from 1 (strongly disagree) to 5 (strongly agree). A mean is calculated across items to create a cumulative score (higher score = more experience with barriers to care).lowest score = 1; highest score = 5. |
| Mean Change in Normative Beliefs About Seeking Mental Health Care | baseline through 2-month follow up | Items assessing subjective norms on seeking mental health care were used from "Perceptions about Services Scale" with scores ranging from 1 (low agreement) to 7 (high agreement). A mean was calculated to create a cumulative score (higher score = greater positive perceptions about seeking mental health care); 1 = lowest score; 7 = highest score. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORElizabeth Karras, PhD
VA Finger Lakes Healthcare System, Canandaigua, NY
Participant flow
Recruitment details
A national random sample was recruited for the trial from December 2022 through April 2025 using the VA and DoD administrative records of those who recently separated from active components of service branches plus activated National Guard/Reservists. These records were queried monthly to randomly select individuals for recruitment, which involved emailing a flyer with a link to a Qualtrics study screener. Follow-up telephone calls were made to enroll those interested and eligible.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 36.4 years STANDARD_DEVIATION 9.9 |
| Education Graduate Degree | 27 Participants |
| Education High School/GED | 38 Participants |
| Education Undergraduate Degree | 153 Participants |
| Employment Employed | 175 Participants |
| Employment Other | 12 Participants |
| Employment Retired | 14 Participants |
| Employment Student | 42 Participants |
| Employment Unemployed | 28 Participants |
| Health Insurance No | 32 Participants |
| Health Insurance Yes | 106 Participants |
| Marital Status Married/cohabitating | 57 Participants |
| Marital Status Never married | 106 Participants |
| Marital Status Widowed/Divorced/Separated/Unknown | 17 Participants |
| Race/Ethnicity, Customized Other than White | 33 Participants |
| Race/Ethnicity, Customized White | 90 Participants |
| Rank at Separation Enlisted | 81 Participants |
| Rank at Separation Officer | 50 Participants |
| Sex: Female, Male Female | 49 Participants |
| Sex: Female, Male Male | 66 Participants |
| Time since military separation 1 year or less | 112 Participants |
| Time since military separation 2 years | 12 Participants |
| Time since military separation 3 years | 1 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 229 | 0 / 232 |
| other Total, other adverse events | 0 / 229 | 0 / 232 |
| serious Total, serious adverse events | 0 / 229 | 0 / 232 |
Outcome results
None listed