Public Messaging for Suicide Prevention in Veterans

No longer recruiting at 1 trial location

Overseen By Elizabeth Karras-Pilato, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Mental health treatment, Impaired, Institutionalized

Compensation: Varies

Number of Visits: 2

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to create and test public messages that encourage veterans at risk for suicide to seek mental health care. It focuses on veterans who have left military service in the past year and aren't currently seeking help, despite experiencing suicidal thoughts. Participants will either receive weekly notifications or watch videos through a mobile app to determine which type of messaging is most effective. Veterans who have separated from service in the last year, experience suicidal thoughts, and are hesitant to seek help, but own a smartphone, might be a good fit for this study.

As an unphased trial, this study offers veterans a unique opportunity to contribute to developing effective mental health outreach strategies.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this messaging strategy is safe for Veterans?

Research has shown that public messaging can safely help prevent suicide among Veterans. One study found that short-term exposure to these safety messages did not cause any significant negative effects on participants, indicating the messages were well-received. Another review of media mental health campaigns found similar results, with no major negative events reported.

For Veterans, previous research suggests that messaging encouraging treatment-seeking is safe. These messages are shared through videos on a mobile app, which other studies have also found to be a safe communication method.

Overall, using public messaging as a treatment is considered safe, with no significant safety concerns reported in the available studies. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how targeted messaging might help prevent suicide among veterans, a group that often faces unique challenges. Unlike traditional treatments for suicide prevention, which typically involve therapy or medication, this approach uses digital technology to deliver supportive video messages directly to participants' smartphones. This method has the potential to reach individuals quickly and at a lower cost, making support more accessible. By using video content, the trial also aims to engage participants emotionally and provide relatable support.

What evidence suggests that public messaging is effective for increasing treatment seeking among Veterans at risk for suicide?

Research shows that public messaging, which participants in this trial may receive, effectively encourages veterans to seek mental health help. Studies have found that communication campaigns can change both thoughts and actions, increasing the likelihood that veterans will reach out for support. One study highlighted that specific techniques in messaging successfully changed beliefs and behaviors. This approach promotes mental health by targeting veterans at risk for suicide. Public messaging campaigns increasingly prevent suicide by reaching large audiences and encouraging them to seek help. Meanwhile, participants in the waitlist control arm will receive weekly push notifications as part of the study's design. ^{2 3 6 7 8}

Who Is on the Research Team?

Elizabeth Karras-Pilato, PhD

Principal Investigator

VA Finger Lakes Healthcare System, Canandaigua, NY

Are You a Good Fit for This Trial?

This trial is for U.S. Veterans over 18 who've left the military in the last year, are experiencing suicidal thoughts, and have low intent to seek help but can consent to participate. They must own a smartphone and be willing to use a study app. Those currently or recently in mental health treatment or institutionalized cannot join.

Inclusion Criteria

I am willing and able to verbally agree to participate.

I am over 18 years old.

I own a smartphone and am willing to use the study app.

Exclusion Criteria

currently institutionalized

I was found to have impairments during my screening.

currently (or in the past 12 months) in formal mental health treatment services

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Message Exposure

Participants exposed to 4 study videos over a one-month period and complete telephone-based assessments

4 weeks

Assessments at baseline, 1-month, and 2-month follow-up

Follow-up

Participants are monitored for changes in treatment initiation and beliefs about mental health

2 months

Telephone-based assessments at 1-month and 2-month follow-up

Wait List Control

Participants receive weekly push notifications while wait-listed

2 months

What Are the Treatments Tested in This Trial?

Interventions

• Messaging
• Wait list control

Trial Overview The study aims to develop and test public messaging strategies designed to encourage Veterans at risk of suicide and resistant to seeking mental health care after leaving the military service, comparing message effectiveness with a wait list control group.

How Is the Trial Designed?

Group I: Message Exposure Experimental Treatment 1 Intervention

Participants exposed to 4 study videos over a one-month period and complete telephone-based assessments at baseline, 1- and 2-month follow up. Study videos are delivered by study's mobile app downloaded to participants' own Smartphone.

Group II: Wait List Control Placebo Group 1 Intervention

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. Telephone-based assessments are completed at baseline, 1- and 2-month follow up. Push notifications are delivered by study's mobile app downloaded to participants' own Smartphone.

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Published Research Related to This Trial

The pilot evaluation of the It's Your Call campaign showed that mixed messaging strategies significantly increased the use of the Veterans Crisis Line among US military veterans, indicating effective communication can promote help-seeking behaviors.

The study, which analyzed daily call data from 10 cities during 2011-2012, suggests that mixed messages are more effective than other strategies in encouraging veterans to reach out for support, highlighting the importance of tailored messaging in suicide prevention efforts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Promoting Help Seeking to Veterans. Karras, E., Lu, N., Elder, H., et al.[2018]

This study suggests that short-term exposure (1 month) to suicide prevention public service announcements (PSAs) can increase help-seeking behaviors among individuals at risk and those concerned about them.

While the results indicate that PSAs may effectively promote help-seeking, the study faced methodological limitations that prevented a clear comparison of the effectiveness between PSAs and printed flyers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluating the Effectiveness in Initiating Help-Seeking Behaviors by Exposure to an Adult Male Public Service Announcement. Reidenberg, D., Berman, A.[2022]

Veterans at risk for suicide responded positively to messages with solemn themes and provocative imagery, indicating that emotionally intense content may be more effective in engaging this population.

Despite recognizing the importance of help-seeking messages, participants felt that actionable steps, like using crisis lines, were not clearly communicated, which could hinder their effectiveness in promoting help-seeking behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perceptions of Public Messaging to Facilitate Help Seeking during Crisis among U.S. Veterans at Risk for Suicide. Karras, E., Arriola, N., McCarten, JM., et al.[2022]

A study involving 33 US veterans identified key reasons why suicide prevention messages may not resonate, including issues with language, imagery, and the credibility of the messenger.

The findings highlight the need for tailored communication strategies to effectively engage veterans in suicide prevention efforts, although the results are limited to a specific group and may not be broadly applicable.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Exploration of Barriers to Suicide Prevention Messaging With US Veterans. Karras, E., Levandowski, BA., McCarten, JM.[2022]

There is a critical need for strategic and science-based messaging to effectively address suicide prevention in US military and veteran populations, as current communications often do not align with prevention goals.

Research highlights the importance of developing consistent and supportive messaging that can enhance suicide prevention efforts, although specific studies on the effectiveness of these communications are currently limited.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using science to improve communications about suicide among military and veteran populations: looking for a few good messages. Langford, L., Litts, D., Pearson, JL.[2022]

A study involving 809 U.S. veterans aged 44 to 65 identified that perceived behavioral control is a major predictor of their intentions to seek help for suicidal behaviors and mental health issues.

The research highlights the importance of understanding veterans' attitudes and social norms when designing effective suicide prevention messaging, suggesting that tailored communication strategies could enhance help-seeking behaviors in this high-risk group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Use of Theory-Based Formative Research to Design Suicide Prevention Messaging for U.S. Veterans in Midlife. Karras, E., Stokes, CM., Warfield, SC., et al.[2022]

A study involving 2526 telephone surveys suggests that media campaigns can effectively promote suicide prevention hotlines specifically to Veteran households.

The findings indicate a need for more research to explore how media campaigns can enhance suicide prevention efforts for Veterans, highlighting their potential value in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using media to promote suicide prevention hotlines to Veteran households. Karras, E., Stephens, B., Kemp, JE., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12478999/

Preventing Veteran Suicide: A Landscape Analysis ... In this study, the authors analyze current and emerging activities to prevent veteran suicide. They introduce the RAND Suicide Prevention ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6381936/

The Use of Theory-Based Formative Research to Design ... Communication campaigns offer a viable mechanism to promote suicide prevention and reinforce mental health for U.S. veterans in midlife, ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0277953619301376

A randomized controlled trial of public messaging to ... To date, several studies of public messaging have applied behavior change frameworks and demonstrated their ability to modify both cognitive and behavioral ...

4. afsp.org afsp.org/grant/public-messaging-strategies-to-facilitate-help-seeking-among-those-at-high-risk-f

Public messaging strategies to facilitate help seeking ... The use of public messaging campaigns is increasingly popular in public health approaches to suicide prevention to broadly target audiences to increase help ...

5. withpower.com withpower.com/trial/phase-suicide-3-2022-d964b

Public Messaging for Suicide Prevention in Veterans 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 ...

6. mentalhealth.va.gov mentalhealth.va.gov/docs/data-sheets/2024/2024-Annual-Report-Part-1-of-2_508.pdf

2024 National Veteran Suicide Prevention Annual Report This ninth annual report provides the most recent data regarding suicide among Veteran and non-Veteran U.S. adults, and about variation in suicide rates across ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11370183/

A Systematic Review of the Impacts of Media Mental Health ... This study addresses the knowledge gap by reviewing the existing literature on the impact of media mental health awareness campaigns on young people.

8. journal-veterans-studies.org journal-veterans-studies.org/articles/10.21061/jvs.v10i1.525

Suicide Prevention Programs Currently Available to US ... A scoping review was conducted to examine what types of suicide prevention programs are currently available for US veterans and their effectiveness.