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In this issue: Preventing Suicide among Veterans
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March 2021

Increasing Help-Seeking Behavior among Transitioning Veterans at Risk for Suicide

Feature Article

Takeaway: This study recruits Veterans and their close supports through online social media advertisements, which allows for broad outreach, suicide prevention targeting Veterans outside the VA network, and the potential to test the effectiveness of gatekeeper training on a large scale. Online gatekeeper trainings are highly scalable public health strategies with the potential to spread through online social networks.

Suicide is an urgent public health crisis, and transitioning Veterans (those who have recently separated from the military) are a high-risk group for suicide. A key component to advancing suicide prevention efforts among at-risk Veterans is to address low levels of help-seeking and engagement in treatment, including VA healthcare. Veterans are most likely to disclose suicidal thoughts to their close supports—family members, friends, and their peers. However, Veterans and their close supports rarely receive training in how to help a peer at risk of suicide, despite strong interest in such training. Gatekeeper training is a key strategy with the potential to help address these challenges. Gatekeeper training teaches “gatekeeper” skills in how to identify a Veteran with suicide risk, inquire about suicidal thoughts, and help make a connection to professional treatment.

Created in partnership with VA, PsychArmor S.A.V.E. (Signs, Ask, Validate, Encourage and Expedite) is a brief, novel online gatekeeper training that was designed for Veterans and their close supports.

This ongoing study (October 2020 – March 2022) is a pilot randomized clinical trial (RCT) that is evaluating the feasibility and acceptability of the online gatekeeper training PsychArmor S.A.V.E., which was designed for Veterans and their close supports. Investigators will recruit 200 participants through social media advertisements targeting transitioning Veterans and their close supports (family and friends). The primary objectives are to:

  • Determine the feasibility of recruiting participants via social media, engaging them to participate in an online training program, and retaining them in an online intervention study;
  • Determine the acceptability of PsychArmor S.A.V.E.; and
  • Evaluate measures for its use in a future larger-scale RCT.


Participants will be randomized to take the PsychArmor S.A.V.E. gatekeeper training or a “sham” control training and followed for six months. Mixed quantitative and qualitative methods will be used to assess outcomes on feasibility and acceptability. Additional data collection and analysis of measures related to suicide prevention, such as gatekeeper behaviors, knowledge, stigma, self-efficacy, and social norms measures will help prepare for a larger-scale RCT.


None to report at this time.

Anticipated Impact

By using an extremely scalable intervention and building off existing VA practices and partnerships, this project will be well-positioned for further evaluation and implementation into VA practice if found to be effective. It is freely available online, making it highly amenable to being rapidly taken to scale. Results of this project also will inform future efforts to disseminate and/or revise PsychArmor S.A.V.E.

Principal Investigator: Alan Teo, MD, MS, is part of HSR&D’s Center to Improve Veteran Involvement in Care (CIVIC) in Portland, OR.


None to report at this time.

View study abstract

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