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2023 HSR&D/QUERI National Conference Abstract

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1179 — Pilot randomized controlled trial of a brief online video training for suicide prevention in military veterans (VA S.A.V.E.)

Lead/Presenter: Alan Teo,  COIN - Portland
All Authors: Teo AR (Center to Improve Veteran Involvement in Care, VA Portland Health Care System), Call AA (Center to Improve Veteran Involvement in Care, VA Portland Health Care System) Hooker ER (Center to Improve Veteran Involvement in Care, VA Portland Health Care System) Gamble SA (Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center) Rodgers C (PsychArmor Institute) Karras E (Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center) Niederhausen M (Oregon Health and Science University) Cross W (Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center) Dobscha SK (Center to Improve Veteran Involvement in Care, VA Portland Health Care System)

Objectives:
VA S.A.V.E. (Signs; Ask; Validate; Encourage/Expedite) is a suicide prevention gatekeeper training that aims to teach caregivers, family, and friends to identify and assist veterans at risk for suicide. VA S.A.V.E. is available in a brief, online video format but has yet to be evaluated in research. The aims of this project were to: a) conduct a pilot, remote randomized controlled trial of VA S.A.V.E., and b) provide a preliminary evaluation of the training, including its feasibility and acceptability.

Methods:
Family and friends of military veterans were recruited through Facebook sponsored ads, randomized to VA S.A.V.E. versus an unrelated video training serving as an attention control, and completed quantitative surveys over six months of follow-up. A subgroup (n = 15) completed interviews, and we used a mixed methods framework to integrate quantitative and qualitative findings.

Results:
Among 214 participants, 61% were spouses or partners of veterans, 96% reported ever worrying that someone they knew was thinking about suicide, 44% worried that someone they knew was thinking about suicide in the prior month, and 48% knew at least one veteran who had died by suicide. Engagement with the VA S.A.V.E. training was high, with 72% of intervention group participants watching at least 70% of the VA S.A.V.E. video and 67% watching the full length. Satisfaction was very high (CSQ-8 median score = 27 [IQR = 24-31]), and usability was excellent (median score = 6 [IQR = 5-6]). At Month 6 follow-up, the VA S.A.V.E. intervention group had a higher proportion of participants use each of the gatekeeper behaviors (66.7-84.9% vs. 44.4-77.1%) and also had a higher total number of gatekeeper behaviors (2.3±0.9 vs. 1.8±1.0), compared to the control group. Themes from interviews converged with, and expanded on, quantitative results. Participants generally had positive reactions and thought VA S.A.V.E. should be shared widely “because we all know somebody [at risk for suicide].” Many participants described feeling “more confident” in their ability to recognize warning signs, ask others directly about suicidal thoughts, and encourage help-seeking. Finally, participants shared specific examples of positive behavior change (e.g., programming the Veterans Crisis Line number into a phone).

Implications:
VA S.A.V.E. merits further investigation into its efficacy as a brief, scalable gatekeeper training for suicide prevention.

Impacts:
VA S.A.V.E. is widely used in the community and in the Department of Veterans Affairs (VA). Study findings will help inform revisions currently underway in the VA’s suicide prevention training curriculum and further dissemination of VA S.A.V.E.