San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.
Departments of Medicine and Psychiatry, University of California San Francisco, San Francisco, California, USA.
J Rural Health. 2021 Sep;37(4):788-800. doi: 10.1111/jrh.12582. Epub 2021 May 12.
To determine the effectiveness of telephone motivational coaching delivered by veteran peers to improve mental health (MH) treatment engagement among veterans.
Veterans receiving primary care from primarily rural VA community-based outpatient clinics were enrolled. Veterans not engaged in MH treatment screening positive for ≥1 MH problem(s) were randomized to receive veteran peer-delivered feedback on MH screen results and referrals plus 4 sessions of telephone motivational coaching (intervention) versus veteran peer-delivered MH results and referrals without motivational coaching (control). Blinded telephone assessments were conducted at baseline, 8, 16, and 32 weeks. Cox proportional hazard models compared MH clinician-directed treatment initiation between groups; descriptive analyses compared MH treatment retention, changes in MH symptoms, quality of life, and self-care.
Among 272 veterans screening positive for ≥1 MH problem(s), 45% who received veteran peer telephone motivational coaching versus 46% of control participants initiated MH treatment (primary outcome) (hazard ratio: 1.09, 95% CI: 0.76-1.57), representing no between-group differences. In contrast, veterans receiving veteran peer motivational coaching achieved significantly greater improvements in depression, posttraumatic stress disorder and cannabis use scores, quality of life domains, and adoption of some self-care strategies than controls (secondary outcomes). Qualitative data revealed that veterans who received veteran peer motivational coaching may no longer have perceived a need for MH treatment.
Among veterans with MH problems using predominantly rural VA community clinics, telephone peer motivational coaching did not enhance MH treatment engagement, but instead had positive effects on MH symptoms, quality of life indicators, and use of self-care strategies.
确定由经验丰富的同行通过电话提供动机性咨询，以提高退伍军人心理健康（MH）治疗参与度的效果。
从主要是农村 VA 社区门诊接受初级保健的退伍军人中招募参与者。对筛查出 MH 问题阳性（≥1 个）但未参与 MH 治疗的退伍军人，随机分配接受退伍军人同行提供的 MH 筛查结果和转诊反馈，外加 4 次电话动机性咨询（干预组），或退伍军人同行提供 MH 结果和转诊但不提供动机性咨询（对照组）。在基线、8、16 和 32 周进行盲法电话评估。Cox 比例风险模型比较了两组之间的 MH 临床医生指导的治疗启动情况；描述性分析比较了 MH 治疗保留率、MH 症状变化、生活质量和自我保健情况。
在筛查出≥1 个 MH 问题的 272 名退伍军人中，接受退伍军人同行电话动机性咨询的退伍军人中，有 45%启动了 MH 治疗（主要结局），而对照组为 46%（风险比：1.09，95%CI：0.76-1.57），组间无差异。相比之下，接受退伍军人同行动机性咨询的退伍军人在抑郁、创伤后应激障碍和大麻使用评分、生活质量领域以及采用一些自我保健策略方面有显著改善，而对照组则没有（次要结局）。定性数据显示，接受退伍军人同行动机性咨询的退伍军人可能不再认为自己需要 MH 治疗。
在使用主要是农村 VA 社区诊所的有 MH 问题的退伍军人中，电话同行动机性咨询并未增强 MH 治疗参与度，但对 MH 症状、生活质量指标和自我保健策略的使用有积极影响。
