Abstract
The LINKS curriculum, adapted from Britt et al. (2018a), was designed to improve unit climate, knowledge, and attitudes about mental health treatment seeking in military personnel. The present study extends this research by examining implementation options, comparing the effectiveness of LINKS to an active control condition with training delivered by non-experts and comparing modules that varied in training length. Eight Army platoons were randomly assigned to one of four conditions: (1) 1-h Active Control, (2) 2-h Active Control, (3) 1-h LINKS, or (4) 2-h LINKS. Two platoons were assigned to each condition. Surveys were administered at pre-training (T1), post-training (T2), and 3 months later (T3). Eighty-four participants completed all study phases. Regardless of training content, participants receiving the 2-h modules reported greater training acceptability than those receiving the 1-h modules. At T3, participants in the LINKS conditions reported more mental health knowledge than participants in the Active Control conditions. Sustained effects were also observed on a number of treatment barriers and facilitators, with the LINKS conditions generally leading to better outcomes. At T3, 2-h LINKS condition participants reported receiving more mental health treatment relative to the other conditions. Findings suggest that LINKS can be effectively delivered by non-expert trainers, is a viable intervention for targeting mental health treatment-seeking, and is optimally packaged in a 2-h module. The training might benefit from additional leadership training efforts.
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References
Adler, A. B. (2013). Resilience in a military occupational health context: Directions for future research. In R. R. Sinclair & T. W. Britt (Eds.), Building psychological resilience in military personnel: Theory and practice (pp. 223–235). Washington, DC: American Psychological Association.
Adler, A. B., Bliese, P. D., McGurk, D., Hoge, C. W., & Castro, C. A. (2009). Battlemind debriefing and battlemind training as early interventions with soldiers returning from Iraq: Randomization by platoon. Journal of Consulting and Clinical Psychology, 77, 928–940.
Adler, A. B., Saboe, K. N., Anderson, J., Sipos, M. L., & Thomas, J. L. (2014). Behavioral health leadership: New directions in occupational mental health. Current Psychiatry Reports, 16, 484.
Adler, A. B., Britt, T. W., Riviere, L. A., Kim, P. Y., & Thomas, J. L. (2015). Longitudinal determinants of behavioral health treatment seeking by U.S. soldiers. The British Journal of Psychiatry, 207, 346–350.
Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In Action Control (pp. 11–39). Springer, Berlin, Heidelberg.
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211. https://doi.org/10.1016/0749-5978(91)90020-T.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191–215.
Boonstra, N., Klaassen, R., Sytema, S., Marshall, M., De Haan, L., Wunderink, L., & Wiersma, D. (2012). Duration of untreated psychosis and negative symptoms–a systematic review and meta-analysis of individual patient data. Schizophrenia Research, 142, 12–19.
Britt, T. W., Black, K. J., Cheung, J. H., Pury, C. L. S., & Zinzow, H. M. (2018a). Unit training to increase support for military personnel with mental health problems. Work & Stress, 1–16.
Britt, T. W., Jennings, K. S., Cheung, J. H., Pury, C. L. S., Zinzow, H. M., Raymond, M. A., & McFadden, A. C. (2016). Determinants of mental health treatment seeking among soldiers who recognize their problem: Implications for high-risk occupations. Work & Stress, 30, 318–336.
Britt, T. W., Wilson, C. A., Sawhney, G., & Black, K. J. (2018b). Unit climate of support for mental health as a predictor of stigma, beliefs about treatment, and help-seeking behaviors. Psychological Services, 16.
Britt, T. W., Wright, K. M., & Moore, D. (2012). Leadership as a predictor of stigma and practical barriers toward receiving mental health treatment: A multilevel approach. Psychological Services, 9, 26.
Colpe, L. J., Naifeh, J. A., Aliaga, P. A., Sampson, N. A., Heeringa, S. G., Stein, M. B., Ursano, R. J., Fullerton, C. S., Nock, M. K., Schoenbaum, M. L., Zaslavsky, A. M., Kessler, R. C., & on behalf of the Army STARRS Collaborators. (2015). Behavioral health treatment among soldiers with current mental disorders in the Army Study to Assess Risk and Resilience in Service Members (Army STARRS). Military Medicine, 180, 1041–1051.
Dell'Osso, B., Glick, I. D., Baldwin, D. S., & Altamura, A. C. (2013). Can long-term outcomes be improved by shortening the duration of untreated illness in psychiatric disorders? A conceptual framework. Psychopathology, 46, 14–21.
Hoge, C. W., Auchterlonie, J. L., & Milliken, C. S. (2006). Mental health problems, use of behavioral health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. Journal of the American Medical Association, 295, 1023–1032.
Hoge, C. W., Grossman, S. H., Auchterlonie, J. L., Riviere, L. A., Milliken, C. S., & Wilk, J. E. (2014). PTSD treatment for soldiers after combat deployment: Low utilization of mental health care and reasons for dropout. Psychiatric Services, 65, 997–1004.
Hoge, C. W., Ivany, C. G., Brusher, E. A., Brown, M. D., Shero, J. C., Adler, A. B., Warner, C. H., & Orman, D. T. (2015). Transformation of mental health care for U.S. soldiers and families during the Iraq and Afghanistan wars: Where science and politics intersect. American Journal of Psychiatry, 173, 334–343.
Hoge, C. W., Lesikar, S. E., Guevara, R., Lange, J., Brundage, J. F., Engel, C. C., Messer, S. C., & Orman, D. T. (2002). Mental disorders among U.S. military personnel in the 1990s: Association with high levels of health care utilization and early military attrition. American Journal of Psychiatry, 159, 1576–1583.
Hoge, C. W., Toboni, H. E., Messer, S. C., Bell, N., Amoroso, P., & Orman, D. T. (2005). The occupational burden of mental disorders in the U.S. military: Psychiatric hospitalizations, involuntary separations, and disability. American Journal of Psychiatry, 162, 585–591.
Hom, M. A., Stanley, I. H., Schneider, M. E., & Joiner Jr., T. E. (2017). A systematic review of help-seeking and mental health service utilization among military service members. Clinical Psychology Review, 53, 59–78.
Kessler, R. C., Heeringa, S. G., Stein, M. B., Colpe, L. J., Fullteron, C. S., Hwang, I., Naifeh, J. A., Nock, M. K., Petukhova, M., Sampson, N. A., Schoenbaum, M., Zaslavsky, A. M., Ursano, R. J., & Army STARRS Collaborators. (2014). Thirty-day prevalence of DSM-IV mental disorders among nondeployed soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Service members (Army STARRS). JAMA Psychiatry, 71, 504–513.
Latané, B., & Darley, J. M. (1970). The unresponsive bystander: Why doesn’t he help? Englewood Cliffs: Prentice Hall.
Maxwell, S. E., Lau, M. Y., & Howard, G. S. (2015). Is psychology suffering from a replication crisis? What does “failure to replicate” really mean? American Psychologist, 70, 487.
Mechanic, D. (1966). Response factors in illness: The study of illness behavior. Social Psychiatry, 1, 11–20.
Mohr, D. C., Spring, B. N., Freedland, K. E., Beckner, V., Arean, P., Hollon, S. D., Ockene, J., & Kaplan, R. (2009). The selection and design of control conditions for randomized controlled trials of psychological interventions. Psychotherapy and Psychosomatics, 78, 275–284.
Prochaska, J., & DiClemente, C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice, 19, 276.
Ramsawh, H. J., Fullerton, C. S., Mash, H. B. H., Ng, T. H. H., Kessler, R. C., Stein, M. B., & Ursano, R. J. (2014). Risk for suicidal behaviors associated with PTSD, depression, and their comorbidity in the U.S. Army. Journal of Affective Disorders, 161, 116–122.
Scott, J. (1988). Social network analysis. Sociology, 22, 109–127.
Sharp, M. L., Fear, N. T., Rona, R. J., Wessely, S., Greenberg, N., Jones, N., & Goodwin, L. (2015). Stigma as a barrier to seeking health care among military personnel with mental health problems. Epidemiologic Reviews, 37, 144–162.
Siegel, J. T., Lienemann, B. A., & Tan, C. N. (2015). Influencing help-seeking among people with elevated depressive symptomatology: Mistargeting as a persuasive technique. Clinical Psychological Science, 3, 242–255.
Vashdi, D. R., Bamberger, P. A., & Bacharach, S. (2012). Effects of job control and situational severity on the timing of help-seeking. Journal of Occupational Health Psychology, 17, 206–219.
Warner, C. H., Appenzeller, G. N., Grieger, T., Belenkiy, S., Breitbach, J., Parker, J., Warner, C. M., & Hoge, C. (2011). Importance of anonymity to encourage honest reporting in mental health screening after combat deployment. Archives of General Psychiatry, 68, 1065–1071.
Wong, L., & Gerras, S. J. (2015). Lying to ourselves: dishonesty in the army profession. Strategic Studies Institute and the U.S: Army War College Press.
Zinzow, H. M., Britt, T. W., Pury, C. L. S., Raymond, M. A., McFadden, A. C., & Burnette, C. M. (2013). Barriers and facilitators of mental health treatment seeking among active-duty army personnel. Military Psychology, 25, 514–535.
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The material has been reviewed by the Walter Reed Army Institute of Research. There is no objection to its presentation and/or publication. The opinions or assertions contained herein are the private views of the author and are not to be construed as official, or as reflecting true views of the Department of the Army or the Department of Defense. The investigators have adhered to the policies for protection of human subjects as prescribed in AR 70–25.
Funding
This study was funded by the Military Operational Medicine Research Program (MOMRP) as part of the Psychological Health and Resilience portfolio (project #20560).
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Start, A.R., Amiya, R.M., Dixon, A.C. et al. LINKS Training and Unit Support for Mental Health: a Group-randomized Effectiveness Trial. Prev Sci 21, 784–794 (2020). https://doi.org/10.1007/s11121-020-01106-6
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DOI: https://doi.org/10.1007/s11121-020-01106-6