Public Messaging to Increase Treatment Seeking for Veterans at Risk for Suicide

Public Messaging to Increase Treatment Seeking Among Veterans at Risk for Suicide During Transition From Military Service

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.

Study Overview

• Status: Completed
• Conditions: Suicide; Mental Health
• Intervention / Treatment: Other: Wait list control; Behavioral: Messaging

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.

• Study Type: Interventional
• Enrollment (Actual): 355
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • New York
    • Canandaigua, New York, United States, 14424-1159
      • VA Finger Lakes Healthcare System, Canandaigua, NY

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 89 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Immediate Message Exposure; Participants complete baseline (T1) and are randomly assigned to immediately receive 4 study videos over the first month. The exposure period ends and participants complete telephone-based assessments at 1- and 2-month follow up (T2 and T3 respectively). Study videos are delivered by study's mobile app downloaded to participants' own Smartphone.	Behavioral: Messaging; Four brief video messages focused on facilitating treatment seeking. Intervention delivered to participant by study mobile app downloaded to participants' own smartphone.
Placebo Comparator: Wait List Control then message exposure at T2; Participants complete baseline and are randomly assigned to the waitlist control. While wait-listed, participants will receive one push notification each week thanking them for participation, informing them that they will receive messages in the near future or reminding them of the length of the study. Following the 1-month follow up (T2), they receive videos over a one month period. The exposure period ends and participants complete the 2-month follow up (T3) assessment by telephone. Videos and push notifications are delivered by study's mobile app downloaded to participants' own Smartphone.	Other: Wait 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.; Behavioral: Messaging; Four brief video messages focused on facilitating treatment seeking. Intervention delivered to participant by study mobile app downloaded to participants' own smartphone.
Placebo Comparator: Wait List Control then message exposure at T3; Participants complete baseline and are randomly assigned to the waitlist control. While wait-listed, participants will receive one push notification each week thanking them for participation, informing them that they will receive messages in the near future or reminding them of the length of the study. Following completion of the 2 month follow-up (T3), participants receive videos over a one month period. They are not assessed post-exposure. Videos and push notifications are delivered by study's mobile app downloaded to participants' own Smartphone.	Other: Wait 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Treatment Initiation	yes to initiating psychological treatment and/or medication/pharmacological treatment in the past month to treat mental health issues.	baseline through 2-month follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Change in Beliefs About Mental Health Treatment	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.	baseline through 2-month follow up
Mean Change in Intentions to Seek Treatment	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.	baseline through 2-month follow up
Mean Change in Perceived Treatment Barriers	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.	baseline through 2-month follow up
Mean Change in Normative Beliefs About Seeking Mental Health Care	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.	baseline through 2-month follow up

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Investigators: Principal Investigator: Elizabeth Karras, PhD, VA Finger Lakes Healthcare System, Canandaigua, NY

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2022
• Primary Completion (Actual): June 30, 2025
• Study Completion (Actual): September 30, 2025

Study Registration Dates

• First Submitted: March 1, 2021
• First Submitted That Met QC Criteria: March 4, 2021
• First Posted (Actual): March 5, 2021

Study Record Updates

• Last Update Posted (Actual): July 9, 2026
• Last Update Submitted That Met QC Criteria: June 11, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: communication; Veterans; public health; treatment engagement
• Additional Relevant MeSH Terms: Behavioral Symptoms; Self-Injurious Behavior; Behavior; Personal Satisfaction; Suicide; Psychological Well-Being; Communication
• Other Study ID Numbers: SDR 19-354; HX003130-01A2 (Other Grant/Funding Number: VA Health Services Research & Development)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Only a Limited Dataset (LDS) will be created and shared pursuant to a Data Use Agreement (DUA) appropriately limiting use of the dataset and prohibiting the recipient from identifying or re-identifying (or taking steps to identify or re-identify) any individual whose data are included in the dataset.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No