There is a paucity of research on evidence-based strategies that can be applied during disasters, especially for Veterans at-risk due to psychiatric disorders and not already engaged in specialty mental healthcare. This pilot evaluated a low-cost self-help intervention to improve mental health and indirectly reduce suicidality among at-risk Veterans during COVID-19. Building on our prior work developing a mailed self-help intervention comprising evidence-based, cognitive-behavioral, self-management strategies, we created Managing Emotions in Disaster and Crisis (MEDIC).
Aims were: 1) Use mixed methods to evaluate implementation outcomes related to delivery of MEDIC; 2) Evaluate whether Veterans receiving MEDIC experience decreases in psychological distress and increases in overall well-being; and c) Explore differences in outcomes between those who received self-help vs. individual or group support.
A total of 120 Veterans (89% enrollment), who either live in a rural area or are in the Veterans Integration to Academic Leadership program (to diversify the sample age) with a current diagnosis of MDD or PTSD and not currently engaged in mental health treatment, were eligible. Veterans chose whether to (a) receive MEDIC materials (2 self-help strategies per week for 4 weeks) via mail or email and (b) opt in to receive three individual or group support appointments (15-30 minutes). Mental health outcomes were assessed pre, post (6 weeks), and follow-up (24 weeks). Feasibility and acceptability of MEDIC was assessed at post. Implementation costs (staff time) were tracked by research staff.
A total of 108 Veterans (89% retention; M age = 51.8 [15.5], 25-79) completed the study at baseline and post and were mostly rural (79%), White (82%), and male (81%). Participants favored mail (62%) over email. 46% chose self-help materials only, 41% chose individual support, and 13% chose group support. Across all participants, 96.3% reported reading 1 week's materials, with 78% reportedly finding the strategies moderately or extremely helpful. On average, distress was in the high range (K10), and PTSD (PCL5), anxiety (GAD7), and depression (PHQ9) symptoms were in the moderate range at baseline. Data show that our primary outcome of psychological distress (K10) decreased significantly from pre to post, M=28.4 (7.2) to M=24.4 (8.0), p<.05, while that reduction was maintained from post to follow up (n=61), M=24.4 (8.6) to 24.6 (8.3), p>.05. Among those with at least moderate symptoms of PTSD or MDD, symptoms also decreased (PCL5: M=38.2 (14.8) to M=34.5 (16.0); PHQ9: M=13.1 (5.7) to M=10.4(5.7), ps<0.05). Suicidal/morbid ideation also decreased from pre to post, as measured by PHQ-9 item 9 (M=0.36 (0.7) to M=0.16 (0.52)). At follow-up, the results revealed the reduction seen at post was maintained across time on the GAD7 (M=9.0 (5.4) to M=8.8 (5.2), p>.05), PHQ9 (M=10.4 (6.2) to 10.8 (6.1), p>.05), and PCL5 (M=33.1 (16.5) to M=31.9 (15.0), p>.05).
Quantitative satisfaction ratings of MEDIC were high (M=27.6 (3.6) out of 32), which matched qualitative data where 87% of participants had a positive experience overall with MEDIC (9% neutral, 5% negative). Rapid qualitative analysis also revealed 96% of those receiving optional support reported experiencing added value beyond the materials, most often commenting on support/caring (67%) and accountability (58%) for individual support and connecting with others (73%) and normalizing one's experience (50%) for group support. Total staff time was 106 hours or <1 hour per Veteran, on average.
Veterans were highly engaged in the self-help intervention and reported numerous benefits while also experiencing decreases in psychological distress over time. Results suggest MEDIC offers a low-intensity, low-cost way to support Veteran mental health during crises/disasters..
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Mental, Cognitive and Behavioral Disorders
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