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

背景：尽管非常需要治疗，但超过一半的有自杀风险的退伍军人没有接受治疗。 启动心理健康服务。这些发现强调了迫切需要增加治疗的战略 在最近分离的退伍军人中寻找易受自我导向的暴力和抵制发起的暴力， 心理健康护理退伍军人事务部已开始定期利用宣传运动，作为公众宣传的一部分， 健康方法，旨在达到更大的退伍军人人口的信息，促进寻求帮助。什么 信息的类型有效地改变信念和行为的风险退伍军人是不清楚的。重要性/ 影响：本研究的主要目标是开发和测试公共信息的使用，以增加 在有自杀风险的退伍军人中寻求治疗，并在以下情况下拒绝寻求精神卫生保健 脱离兵役。创新：研究完成后将产生一个便携式数据驱动的 退伍军人事务部可以以较低的人均成本部署干预措施，以有效地接触和吸引目标 需要心理健康服务的人群。具体目标：目标1：发展公共信息， 在最近分离的退伍军人中寻求治疗的可能性有自杀风险， 心理健康护理目标2：进行一项试验，测试目标1中制定的信息传递，以增加治疗 寻求最近分离的退伍军人在自杀的风险和阻力，以启动精神卫生保健。目标3： 检查信息使用的促进因素和障碍，以确定有效接触和参与的方法 退伍军人在离职后的第一年有自杀风险。方法论：我们提出一个 一项为期四年的混合方法研究，使用顺序嵌入式设计收集全国范围内的数据， 过去从国防部离职的有自杀风险的退伍军人样本， 年在计划行为理论的指导下，首先进行个别访谈， 设计有效的公共信息，随后将在双臂随机对照试验中进行测试，以确定暴露情况 目标受众与对照组之间的效果。将在研究期间向研究参与者传播信息。 研究人员将通过电话收集基线、1-和3- 随机化后个月。将使用以下数据确定潜在参与者（用于所有研究目的）： VA/DOD Identity Repository（VANODE），并通过邀请邮件和后续电话招募。 入选标准：1）在过去12个月内脱离军队服役的美国退伍军人（任何出院） 类型）; 2）>18岁; 3）经历自杀意念; 4）寻求帮助的意愿低; 5）能够 理解研究目标; 6）愿意并能够提供口头同意; 7）智能手机 拥有并愿意下载/使用研究移动的应用程序（针对目标2和3）。排除标准：1）目前（或在 过去12个月）在正式的精神健康治疗服务; 2）在资格期间被视为受损 （3）目前正在进行体制化改革。妇女和少数民族将被纳入研究。下 步骤/实施：如果发现干预措施有效，我们将与VA运营合作伙伴合作， 包括在未来的宣传方法，以防止退伍军人自杀的信息，并利用调查结果，以改善 目前的通信性能指标。

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.