Veteran Perspectives of Barriers and Facilitators to Campaigns Promoting Help Seeking During Crisis
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ORIGINAL PAPER
Veteran Perspectives of Barriers and Facilitators to Campaigns Promoting Help Seeking During Crisis Elizabeth Karras1,2 · Nora Arriola3 · Janet M. McCarten1 · Peter C. Britton1,2 · Karen Besterman‑Dahan3,4 · Tracy A. Stecker1,5 Received: 28 July 2020 / Accepted: 14 October 2020 © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2020
Abstract The objective of this paper is to characterize barriers and facilitators reported by U.S. military veterans related to campaigns promoting help seeking during suicidal crisis. Individual telephone interviews (N = 40) were conducted from August 2018April 2019 with a sample of veterans who had a recent non-fatal suicide attempt. Interview transcripts were analyzed using a constant comparison analytic strategy. Participants reported the four facilitators to message effectiveness: (a) potential reach of specific channels; (b) interruption of suicidal thoughts; (c) normalizing the suicidal experience and help seeking; and (d) modeling desired behavior change. Barriers that hindered campaigns were also identified and include (a) broad messages, (b) challenges in cognitive processing, (c) media avoidance and (d) a boomerang effect. This study underscores the significance of involving those with lived experience to identify factors that may improve or hinder message effectiveness. Keywords Veterans · Public health · Campaigns · Suicide prevention · Crisis
Introduction Suicide is an urgent public health crisis that accounts for more than 45,000 Americans lives each year (Hedegaard et al. 2020). Military veterans contribute disproportionately to the U.S. suicide burden and comprise 14% of all adult suicides (U.S. Department of Veterans Affairs 2019). Effective prevention and treatment can help to reduce the risk for suicide (U.S. Office of the Surgeon General & U.S. National Action Alliance for Suicide Prevention 2012); however, rates of help seeking among at-risk individuals are low (Hoge * Elizabeth Karras Elizabeth.Karras‑[email protected] 1
VA Center of Excellence for Suicide Prevention, Department of Veterans Affairs, VA Finger Lakes Healthcare System, 400 Fort Hill Ave, Canandaigua, NY 14424, USA
2
Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
3
Research Service, Department of Veterans Affairs, James A. Haley VA Hospital, Tampa, FL, USA
4
Department of Nutrition and Dietetics, College of Public Health, University of South Florida, Tampa, FL, USA
5
Department of Nursing, Medical University of South Carolina, Charleston, SC, USA
et al. 2006, 2008). Approximately 11 of the 17 veterans who die by suicide each day have not initiated care from the Veterans Heath Administration (VHA) (U.S. Department of Veterans Affairs 2019). Yet help seeking behaviors are complex and at-risk individuals face multifaceted barriers to seeking mental health care from the VHA or other healthcare system such as logistic and access issues, confidentiality concerns, poor p
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