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This study evaluates the effectiveness of the Veterans Crisis Line on immediate call outcomes (i.e., caller distress, suicidal ideation, and suicidal urgency) for veterans who provide identifying information.Coders rated pre- and post-distress, suicidal ideation, and suicidal urgency for 647 calls from 2019 veteran callers. Intraclass correlation coefficients examined inter-rater reliability. Multilevel generalized linear modeling examined pre-post changes.Inter-rater reliability was good for distress, excellent for suicidal ideation, and fair for urgency. Callers had 5 times greater odds of a reduction in distress (AOR=5.03, 95% CI=3.98, 6.49), almost 5 times greater odds of a reduction in suicidal ideation (AOR=4.92, 95% CI=3.49, 6.94), and 11 times greater odds of a reduction in suicidal urgency (AOR=11.01, 95% CI=2.72, 44.50) at the end of calls than at the beginning.Veterans Crisis Line callers who provide identifying information experience reductions in distress and suicidal ideation during the call. Research is needed to examine the reduction in suicidal urgency because of fair reliability, generalizability of results to other callers, post-call treatment contact and engagement, and risk for suicide attempts and death.

BACKGROUND SAVE (Signs; Ask; Validate; Encourage) is a brief gatekeeper training designed to teach lay individuals how to identify and assist military veterans at risk for suicide. SAVE can be delivered asynchronously using a web-based video format, but no studies of the effectiveness of SAVE exist. OBJECTIVE The aim of this project was to determine the feasibility and acceptability of recruitment and retention in a remote trial of SAVE. METHODS We conducted a social media campaign using sponsored Facebook posts (ads) to recruit veterans, including those outside the Veterans Affairs network of care, and their loved ones. Participants (N=214) were randomized to SAVE or a sham video training unrelated to suicide prevention and followed for 6 months. We also conducted qualitative interviews with a subgroup (n=15) and used a mixed methods framework to integrate findings. RESULTS At baseline, most participants were a family member or friend of a veteran (146/214, 68.2%), and 47.7% (102/214) knew at least one veteran or service member who had died by suicide. Across both study arms, 73.8% (158/214) responded to at least 3 of 6 follow-up surveys and 72.4% (155/214) completed follow-up at 6 months. Themes from interviews indicated the following three barriers to study participation: generic posts, copy (ad text) referring to “research,” and Facebook as a platform. There were 5 facilitators to participation: audience segmentation focused on veterans’ family members and friends, an urgent call to action to help a veteran, prior exposure to suicide, emphasizing the benefits of receiving training, and using a university as the campaign messenger. CONCLUSIONS A social media campaign was a feasible and acceptable approach to recruiting and retaining participants—especially the loved ones of veterans with prior exposure to suicide—for a fully remote trial of SAVE gatekeeper training. Several campaign strategies may be applied to further promote remote study participation in this population. CLINICALTRIAL ClinicalTrials.gov NCT04565951; https://clinicaltrials.gov/ct2/show/NCT04565951

Public stigma is a significant deterrent to mental health service use for U.S. veterans. Media campaigns are often used to dispel stigmatizing beliefs and actions. Segmentation is an evidence-based practice for their effective use; however, little data has been published on veteran segments to target with anti-stigma messages.This article aims to identify and describe initial typologies of stigmatizing attitudes within a group of U.S. military veterans.Telephone-based cross-sectional surveys were conducted with a national random sample of veterans from 2014 to 2016 (A final four-cluster solution was identified among veterans with distinct patterns of attitudes toward mental illness and include: 1) the undecided, 2) the influencer, 3) the ambivalent, and 4) the potential ally. Several strategies were also identified for designing anti-stigma messaging toward these segments.This research demonstrates veterans can be segmented by attitudes to target with anti-stigma campaign messages.

Background SAVE (Signs; Ask; Validate; Encourage) is a brief gatekeeper training designed to teach lay individuals how to identify and assist military veterans at risk for suicide. SAVE can be delivered asynchronously using a web-based video format, but no studies of the effectiveness of SAVE exist. Objective The aim of this project was to determine the feasibility and acceptability of recruitment and retention in a remote trial of SAVE. Methods We conducted a social media campaign using sponsored Facebook posts (ads) to recruit veterans, including those outside the Veterans Affairs network of care, and their loved ones. Participants (N=214) were randomized to SAVE or a sham video training unrelated to suicide prevention and followed for 6 months. We also conducted qualitative interviews with a subgroup (n=15) and used a mixed methods framework to integrate findings. Results At baseline, most participants were a family member or friend of a veteran (146/214, 68.2%), and 47.7% (102/214) knew at least one veteran or service member who had died by suicide. Across both study arms, 73.8% (158/214) responded to at least 3 of 6 follow-up surveys and 72.4% (155/214) completed follow-up at 6 months. Themes from interviews indicated the following three barriers to study participation: generic posts, copy (ad text) referring to “research,” and Facebook as a platform. There were 5 facilitators to participation: audience segmentation focused on veterans’ family members and friends, an urgent call to action to help a veteran, prior exposure to suicide, emphasizing the benefits of receiving training, and using a university as the campaign messenger. Conclusions A social media campaign was a feasible and acceptable approach to recruiting and retaining participants—especially the loved ones of veterans with prior exposure to suicide—for a fully remote trial of SAVE gatekeeper training. Several campaign strategies may be applied to further promote remote study participation in this population. Trial Registration ClinicalTrials.gov NCT04565951; https://clinicaltrials.gov/ct2/show/NCT04565951 Conflicts of Interest None declared.