Research and Evidence-based Approaches

The following studies are a collection of pertinent and applicable articles, studies, and research reports that support the Objective Zero mission and model of connecting the military community to peer support and improving access to resources. While these studies and research stand alone, they form the foundation upon which the Objective Zero mobile app seeks to support veterans, service-members, their families, and military caregivers.

Specifically, the Objective Zero mobile app connects users to peer support, provides access to health and wellness tools, training, and resources, and uses push notification technology to provide resources and caring messages to its users.


Suicide prevention for high-risk persons who refuse treatment

Jerome A. Motto, M.D.

First Published Winter 1976, available at

Abstract: A program was developed to exert a suicide prevention influence on high‐risk persons who decline to enter the health care system. There were 3,006 patients admitted to a psychiatric in‐patient service because of a depressive or suicidal state who were contacted to determine if the post‐discharge plan was followed. Half of those who refused their treatment program were contacted by telephone or letter on a set schedule. The contact was limited to expressing interest in the person's well‐being. Mortality in the contact group was compared with the no‐contact subjects and with the subjects who had accepted treatment, after 1, 2, 3, and 4 years. Suicidal deaths were found to diverge progressively in the three groups, the treatment subjects showing the highest rates, the no‐contact group coming next, and the contact subjects showing the lowest. The observed divergence between the contact and no‐contact groups provides tentative evidence that a high‐risk population for suicide can be identified and that a systematic approach to reducing that risk can be applied.


A randomized controlled trial of post-crisis suicide prevention

Jerome A. Motto, M.D. and Alan G. Bostrom, Ph.D.

Published June, 2001 in Psychiatric Services, vol. 52, No. 6.

ObjectiveThis study tested the hypothesis that professionals’ maintenance of long-term contact with persons who are at risk of suicide can exert a suicide-prevention influence. This influence was hypothesized to result from the development of a feeling of connectedness and to be most pertinent to high-risk individuals who refuse to remain in the health care system. Methods: A total of 3,005 persons hospitalized be- cause of a depressive or suicidal state, populations known to be at risk of subsequent suicide, were contacted 30 days after discharge about fol- low-up treatment. A total of 843 patients who had refused ongoing care were randomly divided into two groups; persons in one group were con- tacted by letter at least four times a year for five years. The other group—the control group—received no further contact. A follow-up procedure identified patients who died during the five-year contact pe- riod and during the subsequent ten years. Suicide rates in the contact and no-contact groups were compared. Results: Patients in the contact group had a lower suicide rate in all five years of the study. Formal survival analyses revealed a significantly lower rate in the contact group (p=.04) for the first two years; differences in the rates gradually diminished, and by year 14 no differences between groups were observed.Conclusions: A systematic program of contact with persons who are at risk of suicide and who refuse to remain in the health care system appears to exert a significant preventive influence for at least two years.


Effect of Augmenting Standard Care for Military Personnel With Brief Caring Text Messages for Suicide Prevention: A Randomized Clinical Trial

Katherine Anne Comtois, PhD, MPH1Amanda H. Kerbrat, MSW1Christopher R. DeCou, PhD1David C. Atkins, PhD1Justine J. Majeres, PsyD2Justin C. Baker, PhD3Richard K. Ries, MD1

JAMA Psychiatry. Published online February 13, 2019. doi:10.1001/jamapsychiatry.2018.4530

Accessible and cost-effective interventions for suicidality are needed to address high rates of suicidal behavior among military service members. Caring Contacts are brief periodic messages that express unconditional care and concern and have been previously shown to prevent suicide deaths, attempts, ideation, and hospitalizations. This randomized clinical trial was conducted at 3 military installations in the southern and western United States. Soldiers and Marines identified as being at risk of suicide were recruited between April 2013 and September 2016. Primary outcomes were current suicidal ideation and suicide risk incidents. Secondary outcomes were worst-point suicidal ideation, emergency department visits, and suicide attempts. Suicidal ideation was measured by the Scale for Suicide Ideation, suicide risk incidents, and emergency department visits by the Treatment History Interview; attempted suicide was measured by the Suicide Attempt Self-Injury Count. This trial provides inconsistent results on the effectiveness of caring text messages between primary and secondary outcomes, but this inexpensive and scalable intervention offers promise for preventing suicide attempts and ideation in military personnel. Additional research is needed.


Social connectedness and psychopathology

Alessandro Rossi, Paolo Stratta, Cristina Capanna

Journal of Psychopathology 2012; 18: 305-308

Research and literature contributions show how low social connected people experience discomfort in social situations, feeling their self misunderstood or isolated, unsatisfied of their relationships. Further, past research confirms that the widespread social and relational difficulties experienced by those with low SC may contribute to more general psychological distress.

Empirical studies found that social connectedness is positively correlated with social competence, hope, and self-esteem, and negatively correlated with anxiety, depressive symptoms, conformity, and psychological distress acting as protective factor leading to fewer interpersonal problems, loneliness, less rejection sensitivity and social avoidance


Revisiting the Rationale and Evidence for Peer Support

Larry Davidson, PhD, Chyrell Bellamy, MSW, PhD, Mathew Chinman, PhD, Marianne Farkas, ScD, Laysha Ostrow, PhD, Judith A. Cook, PhD, Jessica A. Jonikas, MA, Harvey Rosenthal, Sue Bergeson, Allen S. Daniels, EdD, Mark Salzer, PhD

Psychiatric Times, Jun 29, 2018, vol. 35, iss. 6

The rationale for peer support is neither new nor limited to psychiatry. Paid peer support has been around since the birth of the discipline in the late 18th century, with the hiring of recovered patients as staff identified as one of the most essential components of “moral treatment.” Harry Stack Sullivan continued this practice in his hospital in the 1920s, while the milieu therapy models that dominated psychiatry for the following decades relied in large part on the benefits of peer support and role modeling.


A Brief Review of the Conservation of Resources Theory as it Applies to Military Trauma

Jordan Joyner, MS & Valerie Leake, PhD, LCP

Trauma Psychology News, Publication of APA Division 56, Jan 24, 2018, Fall 2018, vol. 13, no. 3

The Conservation of Resource Theory (COR; Hobfoll, 2001) has been found to be a reliable basis for understanding the processes involved with experiencing, coping with, and overcoming chronic and traumatic stress (Hobfoll et al., 2001).  The COR theory postulates that individuals are motivated to protect, procure, and preserve resources (Hobfoll, 1991).  Resources are anything that a person values and can be broken down into four categories: objects (e.g., house, phone), conditions (e.g., stable employment, good health), personal characteristics, (e.g., optimism, hope), and energies (e.g., knowledge).  According to the COR theory, stress results when an individual’s resources are threatened, depleted, or when investment(s) in new resources do not accrue adequately (Hobfoll, 1991; Hobfoll, 2001).  Hobfoll (1991) proposed that traumatic stress results from an accelerated loss of resources, particularly those that are most valued by the individual.  Compared to civilians, United States (U.S.) military personnel have a greater likelihood of experiencing combat trauma through deployment or work-related responsibilities (King et al., 1999; Hobfoll et al., 2012).


Traumatic stress: A theory based on rapid loss of resources

Hobfoll, S.E. (1991)

Anxiety Research, 4(3), 187-197. doi: 10.1080/08917779108248773

Applied Hobfoll's (1988; 1989) Conservation of Resources (COR) stress theory to the instance of traumatic stress. COR theory posits that stress occurs when resources are threatened, when resources are lost, or when individuals invest resources without gaining adequate resources in return. Traumatic stress is seen as particularly threatening to resources and results in rapid resource depletion when it occurs. The rapidness of resource loss is related to the fact that traumatic stressors (1) often attack people's basic values, (2) often occur unexpectedly, (3) make excessive demands, (4) are outside of the realm for which resource utilization strategies have been developed, and (5) leave a powerful mental image that is easily evoked by cues associated with the event. Results from research on traumatic stress are used to illustrate these points and implications for treatment are discussed.