Phase 1: Reaching Veterans Online

How Do We Reach Veterans in Need of Care?

Multiple research studies indicate that only about one-half of veterans with behavioral health needs avail themselves of mental health and substance use services despite the availability of high quality care, such as through the Veterans Affairs Healthcare System (VA). Young veterans, especially those drinking heavily, are particularly resistant to seeking care. Not only do veterans who need help not seek care, but there are unique challenges reaching individuals with behavioral health concerns for research and outreach efforts. Some of these challenges are:

• difficulty scheduling appointments,
• lack of transportation,
• beliefs they can handle problems on their own, and
• stigma related to discussing sensitive matters.

Given these difficulties, the first step of our research project was to find a way to reach veterans in the community who need care but are not receiving it. We proposed that the Internet, mainly the use of the social media network, Facebook, could be a cost-effective and practical method to reach non-treatment seeking veterans for research and programmatic efforts to address behavioral health problems, and in particular, those that were drinking at heavy levels.

1,023 Young Adult Veterans: Sample 1

In the first sample, we recruited 1,023 veteran participants from Facebook in about one month. The sample matched the broader population of young veterans in most areas (e.g., gender, education, marital status), with the exceptions that we enrolled more Army and Marine veterans (and fewer Air Force and Navy veterans) than were represented by the population, and our sample contained a higher percentage of Hispanic/Latino(a) veterans and fewer Black/African American veterans than might be expected in the general population of young adult veterans.

Despite not targeting those veterans with behavioral health problems during recruitment, veterans were diverse in their mental health concerns, substance use patterns, and service use. Approximately 70 percent screened positive for possible PTSD, depression, or hazardous alcohol use, yet less than half of these veterans reported receiving any mental health or substance use care since military discharge and only about half of those with current symptoms reported care use in the past year.

For all veteran respondents:

• Of the 33% that screened positive for hazardous alcohol use, 79% had not attended any appointments for substance use care at a VA clinic or with a non-VA provider within the past year.
• Of the 49% that screened positive for PTSD, 43% had not attended any appointments for mental health care at a VA clinic or with a non-VA provider within the past year.
• Of the 45% that screened positive for generalized anxiety, 41% had not attended any appointments for mental health care at a VA clinic or with a non-VA provider within the past year.
• Of the 38% that screened positive for hazardous alcohol use, 43% had not attended any appointments for mental health care a VA clinic or with a non-VA provider within the past year.

784 Young Adult Veteran Drinkers: Sample 2

For the second sample, inclusion criteria were refined further to include drinkers only. This was because this sample was to receive the brief alcohol intervention we developed. For this sample, we obtained 784 young adult veterans in approximately three weeks. The sample was again well-matched with the broader young veteran population. In this sample, we found 71 percent met criterion for hazardous drinking (per a score on the Alcohol Use Disorder Identification Test of > 8), yet less than ten percent reported use of alcohol treatment from a VA or non-VA facility in the past year. Moreover, although mental health status was not a target of screening, 47 percent of participants screened for possible major depression and 39 percent met criteria for possible PTSD. Yet, as with our first sample, only half of those meeting criteria for depression or PTSD sought mental health care in the past year.

The results from Phase 1 indicated that veterans who are drinking heavily and experiencing mental health problems such as PTSD, generalized anxiety, and depression can be reached through recruitment on Facebook. We are exploring how other social media outreach efforts can help reach veterans that are not engaged in behavioral treatment and assist them with learning more about the options available to them. Reaching young veterans is particularly important to help them begin treatment to address their concerns before these issues turn into chronic problems.

Learn More About Phase 2