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Psychiatric Services , June 2024

This article introduces the youth crises intervention program "Safe Social Space" (SSS), which engages with youth on social media platforms displaying suicidality in their social media posts. 

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Suicide and Life-Threatening Behavior , December 2023

A pilot randomized controlled trial of VA S.A.V.E. suggests it merits further investigation into its effectiveness as a brief video-based gatekeeper training for suicide prevention in veterans.

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World Psychiatry, October 2023

This article proposes use of a structured interview to help evaluate hikikomori and introduces a tool that can help do so.


Journal of General Internal Medicine, June 2023

In a large-scale pragmatic trial in VA primary care and mental health clinics, brief behavioral nudges in appointment reminder letters did not reduce missed appointments. More complex or intensive interventions may be necessary.

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Contemporary Clinical Trials Communication, December 2022

A fully remote trial of VA S.A.V.E. gatekeeper training was feasible in a population of close supports of veterans. Several strategies may further enhance study participation.

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Medical Care, September 2022

There are multiple opportunities to strengthen patients’ sense of belonging within the health care system that serves them. For veterans, strategies that build their sense of belonging may be a novel approach to increase appointment attendance and patient engagement in their health care.


The International Journal of Social Psychiatry, March 2022

Improving the perceived quality of social relationships appears to be a stronger target for depression interventions in the United States than in Tokyo, Japan.

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Journal of Patient Education and Counseling, October 2021

Rapid team-based qualitative analysis, iterative material design, and space in the study design to incorporate entirely new insights from participants into study materials are all approaches that can improve communications of what matters most to a specific population.


Journal of Medical Internet Research, September 2020

We identify a gap in access to suicide prevention training for veterans and in content of current trainings suicide prevention trainings around how to effectively respond to concerning posts from peers.


Journal of General Internal Medicine, September 2020

We identify limitations of appointment reminders and recommend modifications to several aspects of the content, timing, and delivery to make them more effective and patient-centered.


Journal of Affective Disorders, June 2020

Social withdrawal may be associated with other clinical symptoms, social connection, and personality traits in patients with major depressive disorder.


Journal of General Internal Medicine, February 2020

“Being there” represents a novel, patient-generated way to conceptualize and talk about social support. Read the manuscript here.

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World Psychiatry, February 2020

This article presents the criteria for a new, updated definition of hikikomori.


Journal of Medical Internet Research, August 2019

The purpose of this primer was to identify opportunities, as well as potential pitfalls, of conducting qualitative research with Facebook users and their activity on Facebook and provide potential options to address each of these issues.


Journal of Affective Disorders, January 2019

The data we collected demonstrates how more frequent in-person social interaction can be associated with significantly decreased risk of symptoms of major depression and PTSD in veterans.


American Journal of Geriatric Psychiatry, October 2018

Older adults who use video chat such as Skype, but not other common communication technologies, have a lower risk of developing depression.


Psychiatry and Clinical Neurosciences, June 2018 

The 25-item Hikikomori Questionnaire (HQ-25) is a self-report scale of hikikomori; it showed robust psychometric properties and diagnostic accuracy in an initial sample of Japanese adults. 


Journal of Medical Internet Research, July 2018

We found that Facebook advertisement images and headlines may help optimize the effectiveness of advertisements for specific subgroups.


Journal of Affective Disorders, April 2018

This paper addressed how social connectedness is correlated with multiple depression outcomes and that loneliness may be the most important component.


Journal of Medical Internet Research, February 2018

This paper assesses the likelihood of veterans seeking help for depression and suicidal ideation on Facebook as compared to other, more traditional sources of help.

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World Psychiatry, February 2018

Hikikomori is still a hidden epidemic in many countries and, to grasp its worldwide relevance, diagnostic criteria should be included in ICD-11 and future DSM systems.


Psychiatric Services, October 2017

In this continuous quality improvement (CQI) project, we found appointment attendance rates were considerably higher when a phone appointment reminder was live, as compared to voice mail or no answer.


Psychiatric Services, June 2017

In this review of recently published studies, we found several promising approaches, but no definitive standard for either suicide risk assessment or preventative interventions.


BMC Psychiatry, July 2016

This paper assesses the efficacy of a brief, multi-component gatekeeper intervention in promoting suicide prevention in a high-risk Asian community in the United States.


American Journal of Geriatric Psychiatry, October 2016

We conducted a study aimed to determine whether use of certain types of online communication technology is associated with subsequent depressive symptoms.

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General Hospital Psychiatry, March 2016

In this study we found that depressed adults who receive support from loved ones - especially men - rarely use mental health services even though they do often use other health care services.


American Journal of Geriatric Psychiatry, October 2018

We provide evidence that regular in-person social contact reduces risk for developing depression, but connecting via the phone or email do not help stave off depression.


Asia-Pacific Psychiatry, November 2015

This paper shows how movies can be used to educate and engage the public in mental health issues.

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Psychiatry Research, May 2015

In this brief report, we provide some of the first evidence of the existence of a syndrome of social withdrawal not caused by other psychiatric illnesses.

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Suicide and Life-Threatening Behavior, November 2014

Our in-depth interviews with veterans from the Iraq & Afghanistan conflicts revealed that military culture, difficult deployment experiences, and challenges adjusting to life after deployment were three common contributors to their experience having thoughts about suicide.


The International Journal of Social Psychiatry, May 2014

This study is the first to document the presence of hikikomori in multiple countries using the same research definition of the condition.


The Journal of Family Practice, August 2013

This practical report reviews the literature on challenging doctor-patient relationships, then gives helpful tips to primary care doctors on better engaging their patients.


Journal of Anxiety Disorders, May 2013

This study provides a comprehensive review of tools to measure social isolation and quantifies its influence on social anxiety.


Journal of Anxiety Disorders, May 2013

Our analysis of data from thousands of middle-aged Americans shows that the quality of social relationships affects development of depression more so than the quantity of relationships.


Psychiatric Services, November 2012

This study demonstrated that more training and experience for psychiatrists is associated with better ability to predict aggressive behaviors by psychiatric patients.

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Academic Medicine, July 2011

We provide a template for medical educators on designing a capstone course to help students transition into doctors.


The Journal of Nervous & Mental Disease, June 2010

This paper argues that hikikomori is a cultural syndrome and merits further research as a psychiatric condition.


International Journal of Social Psychiatry, March 2010

I provide the first review in the English medical literature of a severe form of social withdrawal called hikikomori.

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Academic Medicine, April 2009

This article outlines several means of training physicians in the conduct of patient-oriented research.

A complete list of publications and other research products is available here.

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