A Virtual Hope Box smartphone app as an accessory to therapy: proof-of-concept in a clinical sample of veterans.

A "Hope Box" is a therapeutic tool employed by clinicians with patients who are having difficulty coping with negative thoughts and stress, including patients who may be at risk of suicide or nonsuicidal self-harm. We conducted a proof-of-concept test of a "Virtual" Hope Box (VHB)-a smartphone app that delivers patient-tailored coping tools. Compared with a conventional hope box integrated into VA behavioral health treatment, high-risk patients and their clinicians used the VHB more regularly and found the VHB beneficial, useful, easy to set up, and said they were likely to use the VHB in the future and recommend the VHB to peers.

Incentives to create and sustain healthy behaviors: technology solutions and research needs.

Health-related technology, its relevance, and its availability are rapidly evolving. Technology offers great potential to minimize and/or mitigate barriers associated with achieving optimal health, performance, and readiness. In support of the U.S. Army Surgeon General's vision for a "System for Health" and its Performance Triad initiative, the U.S. Army Telemedicine and Advanced Technology Research Center hosted a workshop in April 2013 titled "Incentives to Create and Sustain Change for Health." Members of government and academia participated to identify and define the opportunities, gain clarity in leading practices and research gaps, and articulate the characteristics of future technology solutions to create and sustain real change in the health of individuals, the Army, and the nation. The key factors discussed included (1) public health messaging, (2) changing health habits and the environmental influence on health, (3) goal setting and tracking, (4) the role of incentives in behavior change intervention, and (5) the role of peer and social networks in change. This report summarizes the recommendations on how technology solutions could be employed to leverage evidence-based best practices and identifies gaps in research where further investigation is needed.

Utility of the T2 Mood Tracker mobile application among army warrior transition unit service members.

Many military personnel returning from deployment experience increases in psychological symptoms, including post-traumatic stress disorder (PTSD), depression, and mood changes. Patient health diaries are commonly used for self-reporting over time away from the clinic. "T2 Mood Tracker" is an application ("app") for smartphones and other mobile devices that enables users to rate their moods, to self-monitor across time, and to report their emotional experiences to health providers. We designed T2 Mood Tracker to track symptoms associated with deployment-related behavioral health issues, including PTSD, Head Injury, Stress, Depression, Anxiety, and General Well-Being. We field-tested T2 Mood Tracker with a small sample of redeployed soldiers under treatment for behavioral health issues at a Warrior Transition Unit. Participants used the app an average of 10 different days over the 2- to 3-week test period. Consensus was that T2 Mood Tracker was easy to use, useful and beneficial. The majority said they would use the app in the future, would recommend it to other service members, and would use the app to share their mood information with a provider. Warrior Transition Unit providers were enthusiastic about the potential of T2 Mood Tracker as a tool for use with their patients.

Leveraging technology: creating and sustaining changes for health.

OBJECTIVE: The rapid growth and evolution of health-related technology capabilities are driving an established presence in the marketplace and are opening up tremendous potential to minimize and/or mitigate barriers associated with achieving optimal health, performance, and readiness. This article summarizes technology-based strategies that promote healthy habits related to physical activity, nutrition, and sleep. MATERIALS AND METHODS: The Telemedicine and Advanced Technology Research Center convened a workshop titled "Leveraging Technology: Creating & Sustaining Changes for Health" (May 29-30, 2013, Fort Detrick, MD). Participants included experts from academia (n=3), government (n=33), and industry (n=16). A modified Delphi method was used to establish expert consensus in six topic areas: (1) physical activity, (2) nutrition, (3) sleep, (4) incentives for behavior change, (5) usability/interoperability, and (6) mobile health/open platform. RESULTS: Overall, 162 technology features, constructs, and best practices were reviewed and prioritized for physical activity monitors (n=29), nutrition monitors (n=35), sleep monitors (n=24), incentives for change (n=36), usability and interoperability (n=25), and open data (n=13). CONCLUSIONS: Leading practices, gaps, and research needs for technology-based strategies were identified and prioritized. This information can be used to provide a research and development road map for (1) leveraging technology to minimize barriers to enhancing health and (2) facilitating evidence-based techniques to create and sustain healthy behaviors.

Key enablers to facilitate healthy behavior change: workshop summary.

The increases in preventable chronic diseases and the rising costs of health care are unsustainable. The US Army Surgeon General's vision to transition from a health care system to a system of health requires the identification of key health enablers to facilitate the adoption of healthy behaviors. In support of this vision, the US Army Telemedicine and Advanced Technology Research Center hosted a workshop in April 2013 titled "Incentives to Create and Sustain Change for Health." Members of government and academia participated to identify key health enablers that could ultimately be leveraged by technology. The key health enablers discussed included (1) public health messaging, (2) changing health habits and the environmental influence on health, (3) goal setting and tracking, (4) the role of incentives in behavior-change intervention, and (5) the role of peer and social networks on change. This report summarizes leading evidence and the group consensus on evidence-based practices with respect to the key enablers in creating healthy behavior change.

Soldiers' preferences for follow-up communications with behavioral health providers.

BACKGROUND: Recent research has shown value in utilizing follow-up communication with patients to improve long-term outcomes of behavioral health, particularly among the most high-risk patients. MATERIALS AND METHODS: We surveyed 38 active-duty Army personnel who were attached as behavioral health patients to a Warrior Transition Unit at a large military installation to ask their preferences for follow-up communication to behavioral healthcare. RESULTS: Strongest preferences for contact were (1) personal cellphone, (2) text message, and (3) e-mail to non-work account. Because of frequent endorsement of stigma as a barrier to behavioral health treatment in this population, we also evaluated the influence of stigma on follow-up preferences. CONCLUSIONS: "High-stigma" participants indicated less favor for a personal note from a behavioral healthcare provider following treatment, although both high- and low-stigma participants agreed it was a "good idea" for a provider to e-mail a link to a Web site with relevant information about a diagnosis.

Suicides and suicide attempts in the U.S. Military, 2008-2010.

The Department of Defense Suicide Event Report Program collects extensive information on suicides and suicide attempts from the U.S. Air Force, Army, Marine Corps, and Navy. Data are compiled on demographics, suicide event details, behavioral health treatment history, military history, and information about other potential risk factors such as psychosocial stressors that were present at the time of the event. The ultimate goal of this standardized suicide surveillance program is to assist suicide prevention in the U.S. military. Descriptive data are presented on 816 suicides and 1,514 suicide attempts reported through the program between 2008 and 2010.

Addressing the surveillance goal in the National Strategy for Suicide Prevention: the Department of Defense Suicide Event Report.

The US National Strategy for Suicide Prevention (National Strategy) described 11 goals across multiple areas, including suicide surveillance. Consistent with these goals, the Department of Defense (DoD) has engaged aggressively in the area of suicide surveillance. The DoD's population-based surveillance system, the DoD Suicide Event Report (DoDSER) collects information on suicides and suicide attempts for all branches of the military. Data collected includes suicide event details, treatment history, military and psychosocial history, and psychosocial stressors at the time of the event. Lessons learned from the DoDSER program are shared to assist other public health professionals working to address the National Strategy objectives.

Caring Letters Project: a military suicide-prevention pilot program.

BACKGROUND: The Caring Letters Project (CLP) is a suicide prevention program that involves sending brief caring letters to discharged inpatients following psychiatric hospitalization. Several studies suggest that repeatedly sending caring messages may reduce suicides and suicide attempts in high-risk populations. AIMS: The aims of this study were to (1) evaluate feasibility of use in the military setting, (2) explore trends toward reduction of psychiatric rehospitalizations, (3) assess preference for and test e-mail correspondence, and (4) identify best practices and gather data to inform a randomized controlled study. METHODS: A total of 110 psychiatric inpatients at a military treatment facility consented, were interviewed, and then received personalized handwritten letters or e-mails at regular intervals following discharge. Data collected included demographics, clinical characteristics, preference for e-mail versus postal mail, rates of undeliverable and return correspondence, rehospitalizations, and adverse events requiring safety procedures. RESULTS: A total of 436 letters and e-mails have been sent to date. Most participants indicated preference for e-mail versus postal mail. Fifteen participants were readmitted for treatment compared to 20 patients in usual care. Twenty participants sent responses and all were positive statements about the program. There were no adverse events. CONCLUSIONS: This program is feasible for use at a military treatment facility. A randomized controlled trial is needed to determine whether the intervention can reduce suicide rates among military and veteran populations.

Military and civilian media coverage of suicide.

Military suicide has increased over the past decade and reports of Service Member and Veteran suicides receive media attention. Some methods of reporting suicide appear to cause a "media contagion" effect, potentially increasing suicide. This effect is explored in relation to media reports of both military and civilian suicides. To reduce possible contagion, recommendations for media reporting of suicides were adapted by the Suicide Prevention Resource Center (SPRC). We assessed 240 military and civilian newspaper reports of suicide from 15 different sources for compliance with the SPRC guidelines. Nearly all reviewed articles violated at least one guideline. Results highlighted military news articles regarding Service Members included more pejorative language and discussion of failed psychological treatment. Conversely, civilian articles romanticized the victim and provided more details regarding the suicide. Further exploration of military suicide reporting bias is discussed as a need in future research.

Technology-based suicide prevention: current applications and future directions.

This review reports on current and emerging technologies for suicide prevention. Technology-based programs discussed include interactive educational and social networking Web sites, e-mail outreach, and programs that use mobile devices and texting. We describe innovative applications such as virtual worlds, gaming, and text analysis that are currently being developed and applied to suicide prevention and outreach programs. We also discuss the benefits and limitations of technology-based applications and discuss future directions for their use.