Public messaging strategies to facilitate help seeking among those at high risk for both suicide and opioid overdose

Significant increases in the rates of both fatal suicide and opioid overdoses have contributed to a reduced life expectancy for Americans. There is little doubt that these two public health crises are intermingled; individuals with opioid use disorders and/or non-fatal overdoses have a strikingly elevated risk for suicide death. Research is urgently needed on strategies to facilitate help seeking for populations at increased risk for suicide and opioid overdose. The use of public messaging campaigns is increasingly popular in public health approaches to suicide prevention to broadly target audiences to increase help seeking. However, what types of suicide prevention messages effectively change behaviors among populations at highly vulnerable to suicide with intersecting risk opioid overdose is unknown.

The main objective of this study is to identify feasible, acceptable suicide prevention messages to motivate persons vulnerable to suicide with co-occurring risk for opioid overdose to disclose distress and seek formal mental health treatment. The specific aims are as follows: (Aim 1) Examine how individuals interpret and assess existing messages intended to motivate help seeking distinctly for those at high risk for suicide or overdose. Messages are hypothesized to be more salient, understandable and positively appraised when consistent with the perceptions of participants' own health risks. (Aim 2) Identify message characteristics that influence the likelihood to disclose distress and seek mental health treatment among those vulnerable to suicide with co-occurring risk for opioid overdose. We hypothesize distinct language, imagery and persuasive appeals will emerge as motivating across message types (i.e., targeting suicide vs. overdose risks) pointing to a need for the design of tailored suicide prevention messages for use with this group. (Aim 3) Explore preferences for message dissemination to effectively reach and engage those vulnerable to suicide with co-occurring risk for opioid overdose. We hypothesize participants to report the need for tailored dissemination strategies to increase the likelihood that messages are received and processed as intended. 

Data will be collected over two years through individual interviews with a nationwide sample of veteran patients receiving care from the Veterans Health Administration (VA) who recently experienced both a non-fatal suicide attempt and opioid overdose and are not receiving mental health care. Veterans offer an ideal population to begin to examine communicative interventions targeting such outcomes; veteran suicide rates are elevated as compared to the general population with evidence of high risk opioid use among VA patients. An interview guide that reflects the study's conceptual framework will be used to steer open-ended conversations with participants on the mechanisms of persuasive communication. Eligible participants will be identified, and sample will be selected to include some heterogeneity by age, gender and rurality. Constant comparison techniques will be used for analyses to identify and obtain consensus of themes in the data. 

Results will inform a subsequent trial to evaluate the impact of public messaging identified during this study to motivate individuals to seek help when they are at high risk for suicide. These results are of high relevance given the urgent need to identify effective strategies for use in public health approaches to prevent suicide.