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  1. Article ; Online: Feasibility of recruitment and retention in a remote trial of gatekeeper training for close supports of military veterans: Mixed methods study.

    Teo, Alan R / Call, Aaron A / Hooker, Elizabeth R / Fong, Clarissa / Karras, Elizabeth / Dobscha, Steven K

    Contemporary clinical trials communications

    2022  Volume 30, Page(s) 100993

    Abstract: Background: VA S.A.V.E. (Signs; Ask; Validate; Encourage/Expedite) is a gatekeeper training, designed to teach individuals how to identify and assist military veterans at risk for suicide. The aim of this pilot was to determine feasibility, barriers, ... ...

    Abstract Background: VA S.A.V.E. (Signs; Ask; Validate; Encourage/Expedite) is a gatekeeper training, designed to teach individuals how to identify and assist military veterans at risk for suicide. The aim of this pilot was to determine feasibility, barriers, and facilitators of recruitment and retention in a remote trial of VA S.A.V.E.
    Methods: We recruited close supports (family and friends) of veterans through Facebook sponsored ads, automatically randomized them to VA S.A.V.E. or an unrelated video training, and followed them for six months. A subgroup completed interviews, and we used a mixed methods framework to integrate quantitative and qualitative findings.
    Results: Of 214 participants, 61% were spouses or partners of veterans and 48% knew at least one veteran who had died by suicide. Of the three a priori feasibility benchmarks, two were achieved (enrollment, on average, of twenty participants per week and less than 50% loss to follow-up at the 6-month study endpoint) and one was not (enrollment of at least 50% of eligible individuals). There were three barriers (generic ads, ad text referring to "research," and Facebook as an ad platform) and five facilitators (audience segmentation focused on veterans' family members and friends, an urgent call to action to help a veteran, prior exposure to suicide, emphasizing the benefit of receiving training, and using a university as the campaign messenger) to study participation.
    Conclusion: A fully remote trial of VA S.A.V.E. gatekeeper training was feasible in a population of close supports of veterans. Several strategies may further enhance study participation.
    Language English
    Publishing date 2022-09-05
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2451-8654
    ISSN (online) 2451-8654
    DOI 10.1016/j.conctc.2022.100993
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  2. Article ; Online: Brief video training for suicide prevention in veterans: A randomized controlled trial of VA S.A.V.E.

    Teo, Alan R / Hooker, Elizabeth R / Call, Aaron A / Dobscha, Steven K / Gamble, Stephanie / Cross, Wendi F / Rodgers, Carie

    Suicide & life-threatening behavior

    2023  Volume 54, Issue 1, Page(s) 154–166

    Abstract: Introduction: VA S.A.V.E. (Signs; Ask; Validate; Encourage/Expedite) is a gatekeeper training developed by the Department of Veterans Affairs (VA) that teaches individuals to identify and assist veterans at risk for suicide. Although VA S.A.V.E. has ... ...

    Abstract Introduction: VA S.A.V.E. (Signs; Ask; Validate; Encourage/Expedite) is a gatekeeper training developed by the Department of Veterans Affairs (VA) that teaches individuals to identify and assist veterans at risk for suicide. Although VA S.A.V.E. has been widely disseminated, rigorous evaluation is lacking.
    Methods: In a pilot randomized controlled trial of a brief, video-based version of VA S.A.V.E., individuals were recruited through Facebook, randomized to VA S.A.V.E. versus an attention control condition, and completed 6-month follow-up. A subgroup (n = 15) completed interviews. We used a mixed methods framework to integrate quantitative and qualitative findings.
    Results: Among 214 participants, 61% were spouses/partners of veterans and 77% had prior suicide exposure. Sixty-seven percent (n = 68) of VA S.A.V.E. participants watched the entire video, and satisfaction and usability were highly rated. At 6-month follow-up, compared to the control group, the VA S.A.V.E. group had a higher proportion of participants use each gatekeeper behavior (66.7%-84.9% vs. 44.4%-77.1%), and used significantly more total gatekeeper behaviors (2.3 ± 0.9 vs. 1.8 ± 1.0; p = 0.01). Interviews supported positive reactions, learning, and behavior change from VA S.A.V.E.
    Conclusion: VA S.A.V.E. merits further investigation into its effectiveness as a brief, scalable gatekeeper training for suicide prevention in veterans.
    MeSH term(s) Humans ; United States ; Suicide Prevention ; Veterans ; Suicide ; United States Department of Veterans Affairs
    Language English
    Publishing date 2023-12-14
    Publishing country England
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 750058-0
    ISSN 1943-278X ; 0047-4592 ; 0363-0234
    ISSN (online) 1943-278X
    ISSN 0047-4592 ; 0363-0234
    DOI 10.1111/sltb.13028
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  3. Article ; Online: Using Nudges to Reduce Missed Appointments in Primary Care and Mental Health: a Pragmatic Trial.

    Teo, Alan R / Niederhausen, Meike / Handley, Robert / Metcalf, Emily E / Call, Aaron A / Jacob, R Lorie / Zikmund-Fisher, Brian J / Dobscha, Steven K / Kaboli, Peter J

    Journal of general internal medicine

    2023  Volume 38, Issue Suppl 3, Page(s) 894–904

    Abstract: Background: Missed appointments ("no-shows") are a persistent and costly problem in healthcare. Appointment reminders are widely used but usually do not include messages specifically designed to nudge patients to attend appointments.: Objective: To ... ...

    Abstract Background: Missed appointments ("no-shows") are a persistent and costly problem in healthcare. Appointment reminders are widely used but usually do not include messages specifically designed to nudge patients to attend appointments.
    Objective: To determine the effect of incorporating nudges into appointment reminder letters on measures of appointment attendance.
    Design: Cluster randomized controlled pragmatic trial.
    Patients: There were 27,540 patients with 49,598 primary care appointments, and 9420 patients with 38,945 mental health appointments, between October 15, 2020, and October 14, 2021, at one VA medical center and its satellite clinics that were eligible for analysis.
    Interventions: Primary care (n = 231) and mental health (n = 215) providers were randomized to one of five study arms (four nudge arms and usual care as a control) using equal allocation. The nudge arms included varying combinations of brief messages developed with veteran input and based on concepts in behavioral science, including social norms, specific behavioral instructions, and consequences of missing appointments.
    Main measures: Primary and secondary outcomes were missed appointments and canceled appointments, respectively.
    Statistical analysis: Results are based on logistic regression models adjusting for demographic and clinical characteristics, and clustering for clinics and patients.
    Key results: Missed appointment rates in study arms ranged from 10.5 to 12.1% in primary care clinics and 18.0 to 21.9% in mental health clinics. There was no effect of nudges on missed appointment rate in primary care (OR = 1.14, 95%CI = 0.96-1.36, p = 0.15) or mental health (OR = 1.20, 95%CI = 0.90-1.60, p = 0.21) clinics, when comparing the nudge arms to the control arm. When comparing individual nudge arms, no differences in missed appointment rates nor cancellation rates were observed.
    Conclusions: Appointment reminder letters incorporating brief behavioral nudges were ineffective in improving appointment attendance in VA primary care or mental health clinics. More complex or intensive interventions may be necessary to significantly reduce missed appointments below their current rates.
    Trial number: ClinicalTrials.gov, Trial number NCT03850431.
    MeSH term(s) Humans ; Mental Health ; Reminder Systems ; Patient Compliance ; Appointments and Schedules ; Primary Health Care
    Language English
    Publishing date 2023-06-20
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 639008-0
    ISSN 1525-1497 ; 0884-8734
    ISSN (online) 1525-1497
    ISSN 0884-8734
    DOI 10.1007/s11606-023-08131-5
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  4. Article: Correction: Reaching Those At Risk for Psychiatric Disorders and Suicidal Ideation: Facebook Advertisements to Recruit Military Veterans.

    R Teo, Alan / Liebow, Samuel Bl / Chan, Benjamin / Dobscha, Steven K / Graham, Amanda L

    JMIR mental health

    2019  Volume 6, Issue 1, Page(s) e13035

    Abstract: This corrects the article DOI: 10.2196/10078.]. ...

    Abstract [This corrects the article DOI: 10.2196/10078.].
    Language English
    Publishing date 2019-01-09
    Publishing country Canada
    Document type Published Erratum
    ISSN 2368-7959
    ISSN 2368-7959
    DOI 10.2196/13035
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  5. Article ; Online: Feasibility of recruitment and retention in a remote trial of gatekeeper training for close supports of military veterans

    Alan R. Teo / Aaron A. Call / Elizabeth R. Hooker / Clarissa Fong / Elizabeth Karras / Steven K. Dobscha

    Contemporary Clinical Trials Communications, Vol 30, Iss , Pp 100993- (2022)

    Mixed methods study

    2022  

    Abstract: Background: VA S.A.V.E. (Signs; Ask; Validate; Encourage/Expedite) is a gatekeeper training, designed to teach individuals how to identify and assist military veterans at risk for suicide. The aim of this pilot was to determine feasibility, barriers, and ...

    Abstract Background: VA S.A.V.E. (Signs; Ask; Validate; Encourage/Expedite) is a gatekeeper training, designed to teach individuals how to identify and assist military veterans at risk for suicide. The aim of this pilot was to determine feasibility, barriers, and facilitators of recruitment and retention in a remote trial of VA S.A.V.E. Methods: We recruited close supports (family and friends) of veterans through Facebook sponsored ads, automatically randomized them to VA S.A.V.E. or an unrelated video training, and followed them for six months. A subgroup completed interviews, and we used a mixed methods framework to integrate quantitative and qualitative findings. Results: Of 214 participants, 61% were spouses or partners of veterans and 48% knew at least one veteran who had died by suicide. Of the three a priori feasibility benchmarks, two were achieved (enrollment, on average, of twenty participants per week and less than 50% loss to follow-up at the 6-month study endpoint) and one was not (enrollment of at least 50% of eligible individuals). There were three barriers (generic ads, ad text referring to “research,” and Facebook as an ad platform) and five facilitators (audience segmentation focused on veterans’ family members and friends, an urgent call to action to help a veteran, prior exposure to suicide, emphasizing the benefit of receiving training, and using a university as the campaign messenger) to study participation. Conclusion: A fully remote trial of VA S.A.V.E. gatekeeper training was feasible in a population of close supports of veterans. Several strategies may further enhance study participation.
    Keywords suicide ; Social media ; Virtual ; Veterans ; Caregiver ; Medicine (General) ; R5-920
    Subject code 420
    Language English
    Publishing date 2022-12-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Responses to Concerning Posts on Social Media and Their Implications for Suicide Prevention Training for Military Veterans: Qualitative Study.

    Teo, Alan R / Strange, Wynn / Bui, Ricky / Dobscha, Steven K / Ono, Sarah S

    Journal of medical Internet research

    2020  Volume 22, Issue 10, Page(s) e22076

    Abstract: Background: A "concerning post" is a display of a user's emotional crisis on a social media platform. A better understanding of concerning posts is relevant to suicide prevention, but little is known about social media users' attitudes and responses to ... ...

    Abstract Background: A "concerning post" is a display of a user's emotional crisis on a social media platform. A better understanding of concerning posts is relevant to suicide prevention, but little is known about social media users' attitudes and responses to concerning posts. Military veterans in the United States are disproportionately affected by suicide, often use social media, and may have exposure to individuals with elevated suicide risk via concerning posts.
    Objective: The objective of the study was (1) to obtain insight into whether and how US military veterans respond to members of their social network on social media (ie, "friends") who are experiencing substantial emotional distress, and (2) to identify potential interventions that could assist in users' response to concerning posts.
    Methods: We recruited veterans through Facebook and conducted semistructured interviews with 30 participants between June and December 2017. We used a summary template for rapid analysis of each interview, followed by double-coding using a codebook based on topic domains from the interview guide. Members of the research team met regularly to discuss emerging patterns in the data, generate themes, and select representative quotes for inclusion in the manuscript.
    Results: Veterans were reluctant to disclose emotional and health issues on Facebook, but they were open to reaching out to others' concerning posts. There was a complex calculus underlying whether and how veterans responded to a concerning post, which involved considering (1) physical proximity to the person posting, (2) relationship closeness, (3) existing responses to the post, and (4) ability to maintain contact with the person. Veterans desired additional training, backed by community-based veteran organizations, in how to respond to concerning posts from peers.
    Conclusions: There is a need to incorporate features that will help veterans effectively respond to concerning posts from peers into suicide prevention training and to expand access for veterans to such training.
    MeSH term(s) Adult ; Emotions ; Female ; Humans ; Male ; Middle Aged ; Military Personnel/psychology ; Qualitative Research ; Social Media/standards ; Suicide/prevention & control ; United States ; Veterans/psychology ; Young Adult
    Language English
    Publishing date 2020-10-30
    Publishing country Canada
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 2028830-X
    ISSN 1438-8871 ; 1439-4456
    ISSN (online) 1438-8871
    ISSN 1439-4456
    DOI 10.2196/22076
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  7. Article ; Online: The Importance of "Being There": a Qualitative Study of What Veterans with Depression Want in Social Support.

    Teo, Alan R / Marsh, Heather E / Ono, Sarah S / Nicolaidis, Christina / Saha, Somnath / Dobscha, Steven K

    Journal of general internal medicine

    2020  Volume 35, Issue 7, Page(s) 1954–1962

    Abstract: Background: Social connectedness exerts strong influences on health, including major depression and suicide. A major component of social connectedness is having individual relationships with close supports, romantic partners, and other trusted members ... ...

    Abstract Background: Social connectedness exerts strong influences on health, including major depression and suicide. A major component of social connectedness is having individual relationships with close supports, romantic partners, and other trusted members of one's social network.
    Objective: The objective of this study was to understand how individuals' relationships with close supports might be leveraged to improve outcomes for primary care patients with depression and at risk for suicide.
    Design: In this qualitative study, we used a semi-structured interview guide to probe patient experiences, views, and preferences related to social support.
    Participants: We conducted interviews with 30 primary care patients at a Veterans Health Administration (VA) medical center who had symptoms of major depression and a close support.
    Approach: Thematic analysis of qualitative interview data examined close supports' impact on patients. We iteratively developed a codebook, used output from codes to sort data into themes, and selected quotations that exemplified themes for inclusion in this manuscript.
    Key results: "Being there" as an important quality of close supports emerged as a key concept. "Being there" was defined in three ways: physical proximity, frequent or responsive contact, or perceived availability. Close supports who were effective at "being there" possessed skills in intuitively sensing the patient's emotional state and communicating indirectly about depression. Three major barriers to involving close supports in depression care were concerns of overburdening the close support, a perception that awareness of the patient's depression would make the close support unnecessarily worried, and a desire and preference among patients to handle depression on their own.
    Conclusions: "Being there" represents a novel, patient-generated way to conceptualize and talk about social support. Suicide prevention initiatives such as population-level communication campaigns might be improved by incorporating language used by patients and addressing attitudinal barriers to allowing help and involvement of close supports.
    MeSH term(s) Communication ; Depression ; Humans ; Qualitative Research ; Social Support ; Veterans
    Language English
    Publishing date 2020-02-19
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 639008-0
    ISSN 1525-1497 ; 0884-8734
    ISSN (online) 1525-1497
    ISSN 0884-8734
    DOI 10.1007/s11606-020-05692-7
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  8. Article ; Online: A Super-Learner Model for Tumor Motion Prediction and Management in Radiation Therapy: Development and Feasibility Evaluation.

    Lin, Hui / Zou, Wei / Li, Taoran / Feigenberg, Steven J / Teo, Boon-Keng K / Dong, Lei

    Scientific reports

    2019  Volume 9, Issue 1, Page(s) 14868

    Abstract: In cancer radiation therapy, large tumor motion due to respiration can lead to uncertainties in tumor target delineation and treatment delivery, thus making active motion management an essential step in thoracic and abdominal tumor treatment. In current ... ...

    Abstract In cancer radiation therapy, large tumor motion due to respiration can lead to uncertainties in tumor target delineation and treatment delivery, thus making active motion management an essential step in thoracic and abdominal tumor treatment. In current practice, patients with tumor motion may be required to receive two sets of CT scans - the initial free-breathing 4-dimensional CT (4DCT) scan for tumor motion estimation and a second CT scan under appropriate motion management such as breath-hold or abdominal compression. The aim of this study is to assess the feasibility of a predictive model for tumor motion estimation in three-dimensional space based on machine learning algorithms. The model was developed based on sixteen imaging features extracted from non-4D diagnostic CT images and eleven clinical features extracted from the Electronic Health Record (EHR) database of 150 patients to characterize the lung tumor motion. A super-learner model was trained to combine four base machine learning models including the Random Forest, Multi-Layer Perceptron, LightGBM and XGBoost, the hyper-parameters of which were also optimized to obtain the best performance. The outputs of the super-learner model consist of tumor motion predictions in the Superior-Inferior (SI), Anterior-Posterior (AP) and Left-Right (LR) directions, and were compared against tumor motions measured in the free-breathing 4DCT scans. The accuracy of predictions was evaluated using Mean Absolute Error (MAE) and Root Mean Square Error (RMSE) through ten rounds of independent tests. The MAE and RMSE of predictions in the SI direction were 1.23 mm and 1.70 mm; the MAE and RMSE of predictions in the AP direction were 0.81 mm and 1.19 mm, and the MAE and RMSE of predictions in the LR direction were 0.70 mm and 0.95 mm. In addition, the relative feature importance analysis demonstrated that the imaging features are of great importance in the tumor motion prediction compared to the clinical features. Our findings indicate that a super-learner model can accurately predict tumor motion ranges as measured in the 4DCT, and could provide a machine learning framework to assist radiation oncologists in determining the active motion management strategy for patients with large tumor motion.
    MeSH term(s) Gamma Rays/therapeutic use ; Humans ; Image Interpretation, Computer-Assisted ; Lung/diagnostic imaging ; Lung/pathology ; Lung/radiation effects ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/pathology ; Lung Neoplasms/radiotherapy ; Machine Learning/statistics & numerical data ; Movement/physiology ; Radiation Dosage ; Radiotherapy, Computer-Assisted/methods ; Respiration
    Language English
    Publishing date 2019-10-16
    Publishing country England
    Document type Journal Article
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-019-51338-y
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  9. Article ; Online: "Having All of Your Internal Resources Exhausted Beyond Measure and Being Left with No Clean-Up Crew": Defining Autistic Burnout.

    Raymaker, Dora M / Teo, Alan R / Steckler, Nicole A / Lentz, Brandy / Scharer, Mirah / Delos Santos, Austin / Kapp, Steven K / Hunter, Morrigan / Joyce, Andee / Nicolaidis, Christina

    Autism in adulthood : challenges and management

    2020  Volume 2, Issue 2, Page(s) 132–143

    Abstract: Background:: Lay summary: Why was this study done?: ...

    Abstract Background:
    Lay summary: Why was this study done?:
    Language English
    Publishing date 2020-06-10
    Publishing country United States
    Document type Journal Article
    ISSN 2573-959X
    ISSN (online) 2573-959X
    DOI 10.1089/aut.2019.0079
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  10. Article ; Online: Evaluation of the Safety and Design of Community Internet Resources for Veteran Suicide Prevention.

    Chen, Jason I / Mastarone, Ginnifer L / Ambrosino, Santisia A / Anzalone, Nicole / Carlson, Kathleen F / Dobscha, Steven K / Teo, Alan R

    Crisis

    2019  Volume 40, Issue 5, Page(s) 347–354

    MeSH term(s) Consumer Health Information ; Guidelines as Topic ; Help-Seeking Behavior ; Humans ; Internet ; Safety ; Suicidal Ideation ; Suicide/prevention & control ; United States ; Veterans
    Language English
    Publishing date 2019-04-02
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 801380-9
    ISSN 2151-2396 ; 0227-5910
    ISSN (online) 2151-2396
    ISSN 0227-5910
    DOI 10.1027/0227-5910/a000590
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