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A peer veteran approach to the caring letters suicide prevention program: Preliminary data

APA Citation:

Livingston, W. S., Carter, S. P., Leitner, R., Ton, A. T., Gebhardt, H., Zoellner, L. A., Mizik, N., Rojas, S. M., Buchholz, J. R., & Reger, M. A. (2024). A peer veteran approach to the caring letters suicide prevention program: Preliminary data. Psychological Services, 21(1), 1–12. https://doi.org/10.1037/ser0000760

Abstract Created by REACH:

The Caring Letters program is a suicide prevention program that was adapted to military populations to provide peer support to Veterans hospitalized for suicidal ideation. This study examined the feasibility (i.e., enrollment and completion), acceptability (i.e., satisfaction with the program), and preliminary effectiveness (i.e., improvement of mental health outcomes) of this program, in which peer Veterans (n = 15) wrote supportive letters to matched hospitalized Veterans (n = 15) each month for 6 months after discharge. Hospitalized Veterans reported their suicidal ideation and a variety of mental health outcomes (e.g., hopelessness, mental health stigma) at baseline and again at the 6-month follow-up. Preliminary evidence supported the feasibility and acceptability of this program adaptation.


Mental health

Branch of Service:

Multiple branches
Air Force
Marine Corps
Coast Guard

Military Affiliation:


Subject Affiliation:



Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)


Longitudinal Study
Quantitative Study


Livingston, Whitney S., Carter, Sarah P., Leitner, Rebecca, Ton, Andrew T., Gebhardt, Heather, Zoellner, Lori A., Mizik, Natalie, Rojas, Sasha M., Buchholz, Jonathan R., Reger, Mark A.


Caring Letters is a prevention program aimed at reducing suicide risk; however, clinical trials indicate mixed results among military and veteran samples. The present study aimed to pilot a new version of the Caring Letters intervention that was adapted to military culture in order to emphasize peer support. The supportive letters, traditionally sent from clinicians, were written by peer veterans (PVs) who volunteered from local Veteran Service Organizations (VSOs). PVs (n = 15) attended a 4-hr workshop to learn about Caring Letters and write six letters to a veteran with a recent hospitalization for suicide risk (hospitalized veterans [HVs]; n = 15 completed a baseline assessment). Letters from PVs were sent to HVs once a month for 6 months following discharge from the psychiatric inpatient unit. The study used a limited efficacy approach to examine feasibility outcomes including implementation procedures, participant recruitment and retention rates, and barriers and facilitators. Acceptability measures examined HV satisfaction, perceived privacy and safety, and PV workshop satisfaction. Among HVs, results suggested that suicidal ideation improved from baseline to follow-up (g = 3.19). Results suggested resilience scores improved among HVs (g = 0.99). Results also suggested a possible reduction in stigma associated with mental health treatment among PVs at 1-month postworkshop assessment. Interpretation of the results is limited by the design and sample size, but the results provide preliminary support for the feasibility and acceptability of a PV approach to Caring Letters. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Publication Type:

REACH Publication


hospitalization, job satisfaction, military veterans, peers, social support, suicidality, suicide prevention

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REACH Publication Type:

Research Summary

REACH Newsletter:

  August 2023

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