Public messaging to increase treatment seeking among Veterans at risk for suicide during transition from military service

Background: Despite a great need for treatment, more than half of returning Veterans at risk for suicide do not initiate mental health services. Such findings underscore the urgent need for strategies to increase treatment seeking among recently separated Veterans vulnerable to self-directed violence and resistant to initiating mental health care. The 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. What types of messages effectively change beliefs and behaviors for at-risk Veterans is unclear. Significance/ Impact: 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. Innovation: Completion of the study will result in a portable data-driven intervention that can be deployed at low cost per head by VA to effectively reach and engage the target population in need of mental health services. Specific Aims: Aim 1: Develop public messaging to increase the likelihood for treatment seeking among recently separated Veterans at risk for suicide and resistant to initiate mental health care. Aim 2: Conduct a trial testing the messaging developed in Aim 1 to increase treatment seeking for recently separated Veterans at risk for suicide and resistant to initiate mental health care. Aim 3: Examine facilitators and barriers of message use to identify methods for effectively reaching and engaging Veterans at risk for suicide in the first year following separation from service. Methodology: We propose a four-year mixed methods study that uses a sequential embedded design 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 a two-arm RCT to determine exposure effects among targeted audience vs. control group. 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 3- months post-randomization. Potential participants (for all study aims) will be identified using data available from the VA/DOD Identity Repository (VADIR) and recruited by invitational mailing and follow-up telephone calls. Inclusion criteria: 1) U.S. Veteran that separated from military service in the past 12 months (any discharge type); 2) >18 years old; 3) experiencing suicidal ideation; 4) low intent to seek help; 5) capable of understanding the goals of the study; 6) willing and able to provide verbal consent; and 7) smartphone ownership and willing to download/use study mobile app (for Aims 2 & 3). Exclusion criteria: 1) currently (or in the past 12 months) in formal mental health treatment services; 2) deemed impaired during eligibility screening; and 3) currently institutionalized. Women and minorities will be included in the study. Next Steps/Implementation: If the intervention is found effective, we will work with our VA operational partner to include messages in future outreach approaches to prevent Veteran suicide and use findings to improve current communication performance measures.