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2023 HSR&D/QUERI National Conference Abstract

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1009 — A Self-Help Crisis Intervention for At-Risk Veterans with Symptoms of Depression or PTSD: A Pilot Study During the COVID-19 Pandemic

Lead/Presenter: Jennifer Funderburk,  VA Center for Integrated Healthcare
All Authors: Funderburk JS (VA Center for Integrated Healthcare), Shepardson, RL (VA Center for Integrated Healthcare) Possemato, K (VA Center for Integrated Healthcare) Johnson, EM (VA Center for Integrated Healthcare) Roelk, B. (VA Center for Integrated Healthcare) Louer-Thompson, E. (VA Center for Integrated Healthcare) Martin, J. (VA Center for Integrated Healthcare) Wray, L. (VA Center for Integrated Healthcare)

Objectives:
Stressful events, such as the COVID-19 pandemic, mass shootings, or natural disasters, often exacerbate mental health symptoms, leading to increased suicide risk, yet healthcare providers lack evidence-based strategies that can be offered to support patients during crises. We developed Managing Emotions in Disaster and Crisis (MEDIC), a self-help crisis intervention to help Veterans better cope with mood and anxiety symptoms. The purpose of this study was to evaluate the acceptability, effectiveness, and implementation of MEDIC, which was piloted in a sample of primarily rural at-risk Veterans during the COVID-19 pandemic.

Methods:
Veterans with current symptoms (based on positive screens) of Major Depressive Disorder (MDD) or Post-traumatic Stress Disorder (PTSD) who were not engaged in psychotherapy were recruited from VISN 2 VA primary care clinics. 117 Veterans living in rural areas or participating in VA’s Veterans Integration to Academic Leadership (VITAL) program participated in an open trial of MEDIC with rolling recruitment August-December 2020. Veterans were predominantly White (n = 88, 81.5%), lived in rural communities (n = 89, 82.5%), male (n = 87, 80.6%) and ranged from 25-79 years old (M = 51.8). MEDIC was delivered via the Veteran’s choice of mail or email and provided 2 handouts detailing evidence-based, cognitive-behavioral, self-management strategies weekly for 4 weeks. Veterans could also choose optional brief individual or group telephone support calls with a PCMHI provider or peer specialist, respectively. Clinical outcomes including psychological distress; symptoms of MDD, PTSD, and anxiety; and suicidal ideation were assessed using validated measures at baseline, 6-weeks (n = 108), and 6-months (n = 62). Acceptability (e.g., utilization of and satisfaction with MEDIC) and implementation (e.g., staff time for delivery) outcomes were assessed. Paired sample t-tests compared the mean change and McNemar’s test compared the percentage of Veterans endorsing suicidality at baseline versus 6-weeks.

Results:
Intervention engagement/utilization was very high, as Veterans reported reading an average of 7 of 8 handouts, with 88% of those reading any handouts trying at least 1 self-management strategy. Veterans also reported high treatment satisfaction (M = 28 [4] out of 32) with MEDIC. Results showed a decrease in all mental health outcomes (p < .05), including rates of morbid and suicidal ideation (p = .03), from baseline to 6-weeks, with treatment gains maintained at the 6-month follow-up. Staff members on average spent less than one hour of time per Veteran across the 4-week intervention period.

Implications:
While further research using a randomized design with comparison condition is needed, at-risk but non-treatment seeking Veterans receiving the MEDIC intervention were highly engaged and exhibited positive changes in mental health during the stressful COVID-19 pandemic. The intervention was well-received by Veterans and feasible for staff to implement.

Impacts:
MEDIC shows promise as a self-help intervention to enhance Veterans’ mental health and well-being during crises/disasters, which can help to address the need for evidence-based strategies to support at-risk Veterans during stressful events to aid in suicide prevention. The low-intensity format enhances feasibility of implementation in busy primary care clinics. Delivery of MEDIC to rural Veterans may help increase access to evidence-informed care.