1. Technology and Psychology: Helping Military Service Members, Veterans, and their Families
David D. Luxton, PhD. M.S.
Is affiliated with:
University of Washington School of Medicine, Seattle, &
Naval Health Research Center, San Diego CA

2. Agenda Research Highlights
Caring s for Military Suicide Prevention
Telemental health in the US Military
Military Population Health and “Big Data”
Future Direction (and opportunities in technology & Psychology)
DISCLAIMER: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Navy, or the Department of Defense.

3. Areas of Research Focus/Highlights
Mobile Health (mHealth) Technology
Pilot study of videoconferencing telehealth on smartphones
Clinical best practices when integrating into care
Telemental health (to deliver treatments to military personnel/Veterans)
Safety protocols
Clinical assessment via technologies, best practices, etc.
Military suicide prevention (DoD surveillance reports, research, etc.)
Clinical trials & public health studies - PTSD, Depression, suicide, etc.
Technology and Ethics

4. Problem: Military and Veteran Suicide
Rising suicide rate in US military population since 2004
Suicide risk very high for patients who are discharged from psychiatric treatment
Active-Duty (AD) Service member psychiatric patients 5 times the risk of AD population, 8.2 times risk in first month after hospital discharge compared to at 1 year (Luxton et al, 2012)
Makes sense to target this group for intervention...
Psychiatric Services. 64, doi: /appi.ps

5. Caring Contacts for Suicide Prevention
Caring Contacts Intervention: Routine sending of brief, caring messages to high risk for suicide patients after treatment discharge (Luxton, June & Comtois, 2013)
Original caring letters study (Motto,1976; Motto & Bostrom, 2001)
Example Caring Letter:
Simple expressions of care/concern
Non-demanding
Reminder of available resources/way to reconnect with care
Dear ____: It has been some time since you were here at the hospital, and we hope things are going well for you. If you wish to drop us a note, we would be glad to hear from you.

6. Caring Contacts for Suicide Prevention
Caring letters group showed significant < suicide rate in first two years, trended for 14 years.
Other “caring contacts” studies show success (Luxton, June, & Comtois, 2013)
“Caring Letters” intervention one of the only suicide prevention interventions with any initial empirical support
Can augment other suicide prevention/intervention programs in various care settings (inpatient and outpatient)
Crisis, 34, doi: / /a000158

7. Caring Contacts for Suicide Prevention
Caring Letters for Military Suicide Prevention (Luxton, PI)
Military Operational Medicine and Research Program Grant funded multi-site randomized controlled trial (Military Treatment Facilities/ VA Hospitals)
Sending “caring s”
Developed safety protocols

8. Problem: Access to Care and Stigma
Military Health System beneficiaries in remote geographical areas
Cost of travel, not having access to treatments
Stigma associated with seeking care
Injuries limiting mobility
Home-based options (using videoconferencing to provide treatments in the home)
Not presently standard of care in the U.S. military (needs policy to allow)
Need studies to evaluate feasibility, safety and efficacy to inform policy decisions

9. In-home Telemental Health (Cont.)
Grant funded (MOMRP) clinical trial in-home behavioral activation treatment for depression (compares to in-office care) (Luxton/Gahm PIs)
Results show feasible and safe to deliver
Informed leadership at the Defense Heath Agency

10. Problem: What are the short/long-term effects of military deployments on health?
Millennium Cohort Study (Luxton PI)
Examines effect of military experiences and deployments on health (Physical and Psychological) of US Service members, Veterans (and also families (Millennium Cohort Family Study)
Largest (n=200,000) prospective health study in U.S. military history
Comprehensive survey data collection every three years (web and paper formats)
Links to enterprise database systems (“Big Data”)
Informs policy in the DoD, VA, etc.
Photo by SMS Lipp/US Army

11. Department of Veterans Affairs
“Big Data”
Environmental
Exposure Data
Deployment Data
Mortality Data
Pharmacologic
Data
Family Data
Immunization Data
e.g., DoD Birth and
Infant Health Registry
Recruit Assessment Program
Civilian Inpatient and Outpatient Care
Military Inpatient and Outpatient Care
Survey Data
e.g., Millennium Cohort
and Family
Studies
Medical History
DoD Serum Repository
Induction
Demographic Data

12. Future Direction Artificial Intelligence in healthcare
Virtual humans for care
Predictive analytics with big data
Technology and Ethics

13. Future Direction
Virtual Human Cancer Clinical Trial Assistant (Bickmore, Utami et al. 2013).
Institute for Creative Technologies
Relationalagents.com

14. Current/Future Projects
Development/Consultation ( Luxton Labs)
mHealth development
Web-based training
UX design (user design) consultation, testing, and research
Clinical applications consultation
Suicide prevention mHealth apps
Predictive analytics/AI algorithms for risk detection
Virtual Intelligent Agents (Virtual Humans) for behavioral health care applications

15. Opportunities for Psychologists
Develop technology-based interventions/tools that improve the health of people
Collaborate with tech developers, etc.
Research with emerging tech (e.g., virtual humans, mHealth, predictive analytics, etc.)
Bring what we know as psychologists to technologies, e.g.,
Expert knowledge about human/social behavior
Ethics

16. References
Bickmore, T., D. Utami, B. Barry, L. Henault, K. Waite, R. Matsuyama and M. Paasche-Orlow (2013). Enabling Web Search for Low Health Literacy Individuals Using Conversational Agents. Health Literacy Annual Research Conference (HARC). Washington, DC. Luxton, D. D. (2014). Recommendations for the ethical use and design of artificial intelligent care providers. Artificial Intelligence in Medicine. 62(1), doi: /j.artmed Luxton, D. D., (Ed) (2016). Artificial Intelligence in Behavioral and Mental Health Care, Elsevier/Academic Press. Luxton D. D., Trofimovich, L., & Clark, L. L. (2013). Suicide Risk among U.S. Service Members Following Psychiatric Hospitalization, Psychiatric Services. 64, doi: /appi.ps Luxton, D. D., June, J. D. & Comtois, K. A. (2013). Can Post-Discharge Follow-up Contacts Prevent Suicide and Suicide Behavior?: A Review of the Evidence. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 34, doi: / /a Luxton, D. D., June, J. D., Sano, A., & Bickmore, T. (2016). Mobile, Wearable, and Ambient Intelligence in Behavioral Health Care. In D. D. Luxton (Ed). Artificial Intelligence in Behavioral and Mental Health Care. Elsevier Academic Press. Luxton, D. D., Thomas, E. K., Chipps, J., Relova, R. M., Brown, D., McLay, R., et al, (2014). Caring Letters for Suicide Prevention: Implementation of a Multi-Site Randomized Clinical Trial in the U.S. Military and Veteran Affairs Healthcare Systems. Contemporary Clinical Trials. 37(2), doi: /j.cct

17. David D. Luxton, PhD, M.S.