Increasing treatment-seeking intentions of US veterans in the Covid-19 era: A randomized controlled trial

Doron Amsalem, Amit Lazarov, John C Markowitz, Daniel Gorman, Lisa B Dixon, Yuval Neria, Doron Amsalem, Amit Lazarov, John C Markowitz, Daniel Gorman, Lisa B Dixon, Yuval Neria

Abstract

Background: Veterans have higher rates of anxiety, depression, and posttraumatic stress disorder (PTSD), and may be vulnerable to mental health consequences of the Covid-19 pandemic. More than half of veterans who meet mental illness criteria do not seek help. This study screened for clinical symptoms and evaluated the efficacy of a brief, online social-contact-based video intervention in increasing treatment-seeking intentions among veterans. We hypothesized that the video-based intervention would increase treatment-seeking intentions more than written vignette and control conditions.

Methods: One hundred seventy-two veterans were randomized to either a (a) brief video-based intervention; (b) written vignette intervention, or (c) nonintervention control group. In the 3-min video, a veteran previously diagnosed with PTSD described his symptom reactivation by Covid-19, his barriers to care, and how therapy helped him to cope. Assessments were conducted at baseline, postintervention, and at 14- and 30-day follow-ups.

Results: A total of 91 (53%) veterans reported high levels of clinical symptoms, especially those self-reporting Covid-19 exposure. The brief video-based intervention yielded greater increase in treatment-seeking intentions among veterans. Within the video group, women showed an increase in treatment-seeking intentions from baseline to postintervention only, whereas men showed a more sustained effect, from baseline to Day 14.

Conclusions: Surveyed veterans reported high symptoms levels. A brief video intervention increased treatment-seeking intention, likely through identification and emotional engagement with the video protagonist. This easily disseminable video-based intervention has the potential to increase likelihood of seeking care. Future research should examine longer term sustainability and changes in help-seeking behavior.

Trial registration: ClinicalTrials.gov NCT04484207.

Keywords: Covid-19; PTSD; anxiety; depression; help-seeking; intervention; veterans.

Conflict of interest statement

The authors declare that there are no conflict of interests.

© 2021 Wiley Periodicals LLC.

Figures

Figure 1
Figure 1
Study profile
Figure 2
Figure 2
Comparison between Video (n = 86), Vignette (n = 44) and Control (n = 42) Groups on Attitudes Toward Seeking Professional Help Scale (ATTPHS) Over Time. Scores ranged from 3 to 12, with higher scores indicate higher help seeking intentions; F/U. follow‐up
Figure 3
Figure 3
Comparison between Video (n = 54), Vignette (n = 30) and Control (n = 34) Groups on Attitudes Toward Seeking Professional Help Scale (ATTPHS) Over Time among veterans who reported anxiety, depression or PTSD. Scores ranged from 3 to 12, with higher scores indicate higher help seeking intentions; F/U, follow‐up

References

    1. Amsalem, D. , Dixon, L. B. , & Neria, Y. (2020). The coronavirus disease 2019 (COVID‐19) outbreak and mental health. JAMA Psychiatry, 78(1), 9–10. 10.1001/jamapsychiatry.2020.1730
    1. Amsalem, D. , Yang, L. H. , Jankowski, S. , Lieff, S. A. , Markowitz, J. C. , & Dixon, L. B. (2020). Reducing stigma toward individuals with schizophrenia using a brief video: A randomized controlled trial of young adults. Schizophrenia Bulletin, 46(5), 7–14.
    1. Blais, R. K. , & Renshaw, K. D. (2013). Stigma and demographic correlates of help‐seeking intentions in returning service members. Journal of Traumatic Stress, 26(1), 77–85.
    1. Blake, H. , Bermingham, F. , Johnson, G. , & Tabner, A. (2020). Mitigating the psychological impact of covid‐19 on healthcare workers: A digital learning package. International Journal of Environmental Research and Public Health, 17(9), 2997.
    1. Blodgett, J. C. , Avoundjian, T. , Finlay, A. K. , Rosenthal, J. , Asch, S. M. , Maisel, N. C. , & Midboe, A. M. (2015). Prevalence of mental health disorders among justice‐involved veterans. Epidemiologic Reviews, 37, 163–176.
    1. Breslau, N. , Peterson, E. L. , & Schultz, L. R. (2008). A second look at prior trauma and the posttraumatic stress disorder effects of subsequent trauma. Archives of General Psychiatry, 65(4), 431–437.
    1. Clement, S. , Schauman, O. , Graham, T. , Maggioni, F. , Evans‐Lacko, S. , Bezborodovs, N. , Morgan, C. , Rüsch, N. , Brown, J. S. L. , & Thornicroft, G. (2015). What is the impact of mental health‐related stigma on help‐seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27.
    1. Corrigan, P. , Michaels, P. J. , & Morris, S. (2015). Do the effects of antistigma programs persist over time? Findings from a meta‐analysis. Psychiatric Services, 66(5), 543–546.
    1. Corrigan, P. W. , Michaels, P. J. , Vega, E. , Gause, M. , Larson, J. , Krzyzanowski, R. , & Botcheva, L. (2014). Key ingredients to contact‐based stigma change: A cross‐validation. Psychiatric Rehabilitation Journal, 37(1), 62–64.
    1. Corrigan, P. W. , Vega, E. , Larson, J. , Michaels, P. J. , McClintock, G. , Krzyzanowski, R. , Gause, M. , & Buchholz, B. (2013). The California schedule of key ingredients for contact‐based antistigma programs. Psychiatric Rehabilitation Journal, 36(3), 173–179.
    1. Cunningham, J. A. , Godinho, A. , & Kushnir, V. (2017). Can Amazon's Mechanical Turk be used to recruit participants for internet intervention trials? A pilot study involving a randomized controlled trial of a brief online intervention for hazardous alcohol use. Internet Interv, 1(10), 12–16.
    1. Dell'Osso, B. , Glick, I. , Baldwin, D. , & Altamura, A. (2013). Can long‐term outcomes be improved by shortening the duration of untreated illness in psychiatric Disorders? A conceptual framework. Psychopathology, 46(1), 14–21.
    1. Elhai, J. D. , Schweinle, W. , & Anderson, S. M. (2008). Reliability and validity of the Attitudes Toward Seeking Professional Psychological Help Scale‐Short Form. Psychiatry Research, 159(3), 320–329.
    1. Fortney, J. C. , Curran, G. M. , Hunt, J. B. , Cheney, A. M. , Lu, L. , Valenstein, M. , & Eisenberg, D. (2016). Prevalence of probable mental disorders and help‐seeking behaviors among veteran and non‐veteran community college students. General Hospital Psychiatry, 38, 99–104.
    1. Hamblen, J. L. , Grubaugh, A. L. , Davidson, T. M. , Borkman, A. L. , Bunnell, B. E. , & Ruggiero, K. J. (2019). An online peer educational campaign to reduce stigma and improve help seeking in veterans with posttraumatic stress disorder. Telemed e‐Health, 25(1), 41–47.
    1. Hoge, C. W. , Castro, C. A. , Messer, S. C. , McGurk, D. , Cotting, D. I. , & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13–22.
    1. Hurtado, S. L. , Simon‐Arndt, C. M. , Schmied, E. A. , Belding, J. N. , Subala, R. S. , & Richardson, C. M. (2019). Use of an educational video to reduce barriers to military mental health care. Psychiatric Services, 70(10), 915–920.
    1. Iversen, A. C. , Van Staden, L. , Hughes, J. H. , Greenberg, N. , Hotopf, M. , Rona, R. J. , Thornicroft, G. , Wessely, S. , & Fear, N. T. (2011). The stigma of mental health problems and other barriers to care in the UK Armed Forces. BMC Health Services Research, 11, 31.
    1. Janoušková, M. , Tušková, E. , Weissová, A. , Trančík, P. , Pasz, J. , Evans‐Lacko, S. , & Winkler, P. (2017). Can video interventions be used to effectively destigmatize mental illness among young people? A systematic review. European Psychiatry, 41, 1–9.
    1. Kehle, S. M. , Polusny, M. A. , Murdoch, M. , Erbes, C. R. , Arbisi, P. A. , Thuras, P. , & Meis, L. A. (2010). Early mental health treatment‐seeking among U.S. National Guard soldiers deployed to Iraq. Journal of Traumatic Stress, 23(1), 33–40.
    1. Koike, S. , Yamaguchi, S. , Ojio, Y. , Ohta, K. , Shimada, T. , Watanabe, K. , Thornicroft, G. , & Ando, S. (2018). A randomised controlled trial of repeated filmed social contact on reducing mental illness‐related stigma in young adults. Epidemiology and Psychiatric Sciences, 27(2), 199–208.
    1. Kraus, C. , Kadriu, B. , Lanzenberger, R. , Zarate, C. A. , & Kasper, S. (2019). Prognosis and improved outcomes in major depression: A review. Translational Psychiatry, 9(1), 127.
    1. Kroenke, K. , Spitzer, R. L. , & Williams, J. B. W. (2001). The PHQ‐9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.
    1. Lazar, S. G. (2014). The mental health needs of military service members and veterans. Psychodyn Psychiatry, 42(3), 459–478.
    1. Levis, B. , Benedetti, A. , & Thombs, B. D. (2019). Accuracy of Patient Health Questionnaire‐9 (PHQ‐9) for screening to detect major depression: Individual participant data meta‐analysis. BMJ, 365, 1476.
    1. Li, Y. , Sorrentino, R. , Norman, R. , Hampson, E. , & Ye, Y. (2017). Effects of symptom versus recovery video, similarity, and uncertainty orientation on the stigmatization of schizophrenia. Personality and Individual Differences, 106, 117–121.
    1. Murphy, D. , Williamson, C. , Baumann, J. , Busuttil, W. , & Fear, N. T. (2020). Exploring the impact of COVID‐19 and restrictions to daily living as a result of social distancing within veterans with pre‐existing mental health difficulties. BMJ Mil Heal, bmjmilitary‐2020‐001622. online ahead of print.
    1. Ouimette, P. , Wade, M. , Prins, A. , & Schohn, M. (2008). Identifying PTSD in primary care: Comparison of the primary care‐PTSD screen (PC‐PTSD) and the General Health Questionnaire‐12 (GHQ). Journal of Anxiety Disorders, 22(2), 337–343.
    1. Paolacci, G. , Chandler, J. , & Ipeirotis, P. G. (2010). Running experiments on Amazon mechanical turk. Judgm Decis Mak, 5, 411–419.
    1. Pappa, S. , Ntella, V. , Giannakas, T. , Giannakoulis, V. G. , Papoutsi, E. , & Katsaounou, P. (2020). Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID‐19 pandemic: A systematic review and meta‐analysis. Brain, Behavior, and Immunity, 88, 901–907.
    1. Perinelli, E. , & Gremigni, P. (2016). Use of social desirability scales in clinical psychology: A systematic review. Journal of Clinical Psychology, 72(6), 534–551.
    1. Pfefferbaum, B. , & North, C. S. (2020). Mental health and the Covid‐19 pandemic. New England Journal of Medicine, 383, 510–512.
    1. Picco, L. , Abdin, E. , Chong, S. A. , Pang, S. , Shafie, S. , Chua, B. Y. , Vaingankar, J. A. , Ong, L. P. , Tay, J. , & Subramaniam, M. (2016). Attitudes toward seeking professional psychological help: Factor structure and socio‐demographic predictors. Frontiers in Psychology, 7, 547.
    1. Prins, A. , Bovin, M. J. , Smolenski, D. J. , Marx, B. P. , Kimerling, R. , Jenkins‐Guarnieri, M. A. , Kaloupek, D. G. , Schnurr, P. P. , Kaiser, A. P. , Leyva, Y. E. , & Tiet, Q. Q. (2016). The primary care PTSD screen for DSM‐5 (PC‐PTSD‐5): Development and evaluation within a veteran primary care sample. Journal of General Internal Medicine, 31(10), 1206–1211.
    1. Rosen, C. , Tiet, Q. , Cavella, S. , Finney, J. , & Lee, T. (2005). Chronic PTSD patients' functioning before and after the September 11 attacks. Journal of Traumatic Stress, 18(6), 781–784.
    1. Serrano‐Ripoll, M. J. , Meneses‐Echavez, J. F. , Ricci‐Cabello, I. , Fraile‐Navarro, D. , Fiol‐deRoque, M. A. , Pastor‐Moreno, G. , Castro, A. , Ruiz‐Pérez, I. , Zamanillo Campos, R. , & Gonçalves‐Bradley, D. C. (2020). Impact of viral epidemic outbreaks on mental health of healthcare workers: A rapid systematic review and meta‐analysis. Journal of Affective Disorders, 277, 347–357.
    1. Sharp, M. L. , Fear, N. T. , Rona, R. J. , Wessely, S. , Greenberg, N. , Jones, N. , & Goodwin, L. (2015). Stigma as a barrier to seeking health care among military personnel with mental health problems. Epidemiologic Reviews, 37, 144–162.
    1. Spitzer, R. L. , Kroenke, K. , Williams, J. B. W. , & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD‐7. Archives of Internal Medicine, 166(10), 1092–1097.
    1. Thornicroft, G. , Mehta, N. , Clement, S. , Evans‐Lacko, S. , Doherty, M. , Rose, D. , Koschorke, M. , Shidhaye, R. , O'Reilly, C. , & Henderson, C. (2016). Evidence for effective interventions to reduce mental‐health‐related stigma and discrimination. Lancet, 387(10023), 1123–1132.
    1. Trivedi, R. B. , Post, E. P. , Sun, H. , Pomerantz, A. , Saxon, A. J. , Piette, J. D. , Maynard, C. , Arnow, B. , Curtis, I. , Fihn, S. D. , & Nelson, K. (2015). Prevalence, comorbidity, and prognosis of mental health among US veterans. American Journal of Public Health, 105(12), 2564–2569.
    1. Vens, M. , & Ziegler, A. (2012). Generalized estimating equations and regression diagnostics for longitudinal controlled clinical trials: A case study. Computational statistics & data analysis, 56, 1231–1242.
    1. Wild, J. , Smith, K. V. , Thompson, E. , Béar, F. , Lommen, M. J. J. , & Ehlers, A. (2016). A prospective study of pre‐trauma risk factors for post‐traumatic stress disorder and depression. Psychological Medicine, 46(12), 2571–2582.
    1. Zeger, S. L. , & Liang, K.‐Y. (1986). Longitudinal Data Analysis for Discrete and Continuous Outcomes. Biometrics, 42, 121–130.
    1. Zeger, S. L. , Liang, K.‐Y. , & Albert, P. S. (1988). Models for Longitudinal Data: A Generalized Estimating Equation Approach. Biometrics, 44, 1049–1060.

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