# Randomized Evaluation of a Caring Letters Suicide Prevention Campaign for Service Members Transitioning to Civilian Life

> **NIH VA I50** · VA PUGET SOUND HEALTHCARE SYSTEM · 2020 · —

## Abstract

ABSTRACT
Service members transitioning to civilian life have suicide rates that are 63% higher than other service
members, and rates are especially high in the first year after separation from service. Therefore, the President
issued an Executive Order that requires the Department of Veteran Affairs (VA) to develop a plan to provide,
suicide prevention resources to transitioning service members in the year following separation from service. In
response, VA’s Central Office Suicide Prevention Program (SPP) plans to implement a Caring Letters
campaign for all 245,000 service members who transition each year. In the Caring Letters intervention, a series
of messages are sent to individuals to communicate that they are not forgotten, and that people care about
them and are concerned for their well-being. The messages also serve as a reminder that help is available.
Multiple randomized clinical trials support the efficacy of Caring Letters for reducing suicide and suicide
attempt rates. The Joint Commission has recently promoted Caring Letters. The campaign for transitioning
service members faces some unique challenges, however, since there is no established VA provider to serve
as the signatory. Therefore, we propose a partnered program evaluation between SPP and the proposed
evaluation team to examine the use of Caring Letters in this new population. Specifically, the evaluation will
test two models: (1) A modified approach to Caring Letters in which letters are sent from a VA provider the
Veteran does not know, and (2) a culturally-sensitive peer-based approach to Caring Letters in which letters
are sent from recently transitioned service members matched on sex and military service branch. The
campaign will also randomize service members to a standard mailing schedule (8 messages in a year) or a
high frequency schedule (14 messages in a year). In Aim 1, we will evaluate the effects of Caring Letters on
clinical outcomes and VA clinical utilization rates. In Aim 2, we will examine the effects of the two different
Caring Letter signatories and two different mailing schedules on the clinical effectiveness of the intervention.
Aim 3 will examine facilitators and barriers to implementing the Caring Letters campaign. In Aim 4, we will
conduct budget impact analyses of implementation from the VA perspective. This will be the largest evaluation
of a Caring Letters intervention ever conducted, and it will provide direct and actionable data to leadership to
evaluate the impacts of this major prevention campaign.

## Key facts

- **NIH application ID:** 9718807
- **Project number:** 1I50HX002793-01
- **Recipient organization:** VA PUGET SOUND HEALTHCARE SYSTEM
- **Principal Investigator:** Mark A. Reger
- **Activity code:** I50 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2019-04-01 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9718807

## Citation

> US National Institutes of Health, RePORTER application 9718807, Randomized Evaluation of a Caring Letters Suicide Prevention Campaign for Service Members Transitioning to Civilian Life (1I50HX002793-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9718807. Licensed CC0.

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