Disaster Mental Health
Patient Feedback on Utility of Mental Health Self-Management Strategies within a Crisis Self-Help Intervention
Robyn L. Shepardson, Ph.D.
Clinical Research Psychologist
VA Center for Integrated Healthcare
Syracuse, New York
Jennifer S. Funderburk, Ph.D.
Clinical Research Psychologist
VA Center for Integrated Healthcare
Syracuse, New York
Ramifications of crises including the COVID-19 pandemic (e.g., quarantines) may place individuals with psychiatric disorders such as major depressive disorder (MDD) or posttraumatic stress disorder (PTSD) at further risk for distress. There is a dearth of research on evidence-based interventions for use in disasters/crises, especially for those not already engaged in mental health care. To increase access to evidence-informed self-management strategies, we developed a low-cost mail or email delivered crisis self-help intervention to improve adaptive coping and thus reduce distress and MDD/PTSD symptoms. Each week for 4 weeks, participants received 1 caring letter and 2 handouts detailing cognitive-behavioral self-management strategies identified in Delphi studies as likely to be both feasible and effective (e.g., seek social support, use relaxation exercises). The purpose of this study was to examine patient feedback on the feasibility, acceptability, and utility of self-management strategies used during a crisis. Participants were 117 Veteran primary care patients (20% female, 18% non-White, 9% Hispanic/Latino/a, mean age = 51 [15.4] years) screening positive for MDD or PTSD symptoms but not engaged in psychotherapy recruited from VA facilities in Upstate New York. At the 6-week post assessment, 108 completed Likert-scale feedback items and a subset of 34 completed qualitative interviews, for which we used descriptive statistics and rapid analysis, respectively. Participants reported reading an average of 6.9 (2.0) strategy handouts out of 8. Most participants reported the strategies they tried were moderately or extremely easy to use (89%) and moderately or extremely helpful (84%), and they were moderately or extremely likely to continue using them after the study (88%). Using relaxation exercises and engaging in meaningful activities were identified in interviews as the most helpful strategies. While few strategies were perceived as unhelpful, improving sleep habits was considered the least helpful by 22% (due to having long-standing sleep problems). Themes from interviews included self-management strategies increasing awareness of thoughts and behaviors, which then facilitated taking action to relax or boost mood; realizations that simple/brief behaviors (e.g., going for a walk, taking deep breaths) can make a difference; and the intervention providing a needed reminder to use coping strategies previously learned. Overall, our findings suggest that patients were able to use cognitive-behavioral self-management skills and found them helpful within the context of a crisis self-help intervention piloted during the COVID-19 pandemic. Further research should continue to test crisis interventions using accessible self-help formats.