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，但有自杀风险的退伍军人中，超过一半的人没有 启动心理健康服务。这些发现突显了增加治疗的战略的迫切需要。 在最近分居的退伍军人中寻找易受自我定向暴力和抵制发起的人 心理健康护理。退伍军人事务部已开始定期使用宣传活动，作为公众活动的一部分 旨在通过宣传寻求帮助的信息接触到更多的退伍军人群体的健康方法。什么 消息的类型有效地改变了高危退伍军人的信念和行为尚不清楚。重要性/ 影响：这项研究的主要目标是开发和测试公共消息传递的使用，以增加 有自杀风险的退伍军人寻求治疗并抵制寻求心理健康护理 从兵役中分离。创新：这项研究的完成将导致便携式数据驱动 可由退伍军人管理局以低人均成本部署的干预措施，以有效地达到目标并参与其中 需要心理健康服务的人群。具体目标：目标1：发展公共信息以增加 最近分居的有自杀风险和抵制启动的退伍军人寻求治疗的可能性 心理健康护理。目标2：进行一项试验，测试在目标1中开发的消息传递以增加治疗 寻找最近分居的退伍军人，有自杀风险，并抵制启动心理健康护理。目标3： 检查信息使用的促进者和障碍，以确定有效接触和参与的方法 退伍军人在退役后的第一年有自杀的危险。方法：我们提出了一种 为期四年的混合方法研究，使用顺序嵌入式设计从全国范围内收集数据 过去与国防部分离的未接受精神健康治疗的有自杀风险的退伍军人样本 年。在计划行为理论的启发下，首先将进行个人访谈，以指导 设计有效的公共信息，随后将在双臂RCT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。信息将在研究期间向研究参与者传播 这是一款智能手机应用程序的试用。研究人员将在基线、1-和3-通过电话收集评估 随机化后几个月。将使用以下数据确定潜在参与者(针对所有研究目标) 退伍军人事务部/国防部身份库(VADIR)，并通过邀请函和后续电话招募。 入选标准：1)美国退伍军人在过去12个月内退伍(任何退役 类型)；2)&gt；18岁；3)有自杀意念；4)寻求帮助意向低；5)有能力 了解研究目标；6)愿意并能够提供口头同意；7)智能手机 拥有并愿意下载/使用学习移动应用程序(目标2和3)。排除标准：1)当前(或在 过去12个月)在正式的精神健康治疗服务中；2)在符合资格期间被视为受损 筛查；以及3)目前被制度化。女性和少数民族将被包括在这项研究中。下一首 步骤/实施：如果发现干预有效，我们将与退伍军人管理局运营合作伙伴合作 将信息包括在未来的外展方法中，以防止退伍军人自杀并利用调查结果进行改进 当前通信性能衡量标准。

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.