The introductory poem that the sixteenth-century Italian Jew, Samuel Sarfati, included with his now lost Hebrew translation of Fernando de Rojas' Spanish masterpiece, "La Celestina", mentions several elements foreign to Rojas' work as we know it today. These include the image of the war of lovers, the description of women as the Angels of Death and as the Devil (Azazel), and the identification of sexual desire and religious assimilation. In my opinion these elements show that Sarfati had in mind two earlier works from the Judeo-Spanish go-between tradition. "Minhat Yehuda" by Judah ibn Sabbatay and the "Maqama of Marriage" by Judah al-Harizi. In both of these Hebrew works we find images similar to those used by Sarfati, as well as some strikingly similar formal and linguistic characteristics, all of which suggests that these two works were part of the historical-literary background of Sarfati (and, perhaps, Rojas himself).

Purpose

To determine the effectiveness of telephone motivational coaching delivered by veteran peers to improve mental health (MH) treatment engagement among veterans.

Methods

Veterans receiving primary care from primarily rural VA community-based outpatient clinics were enrolled. Veterans not engaged in MH treatment screening positive for ≥1 MH problem(s) were randomized to receive veteran peer-delivered feedback on MH screen results and referrals plus 4 sessions of telephone motivational coaching (intervention) versus veteran peer-delivered MH results and referrals without motivational coaching (control). Blinded telephone assessments were conducted at baseline, 8, 16, and 32 weeks. Cox proportional hazard models compared MH clinician-directed treatment initiation between groups; descriptive analyses compared MH treatment retention, changes in MH symptoms, quality of life, and self-care.

Findings

Among 272 veterans screening positive for ≥1 MH problem(s), 45% who received veteran peer telephone motivational coaching versus 46% of control participants initiated MH treatment (primary outcome) (hazard ratio: 1.09, 95% CI: 0.76-1.57), representing no between-group differences. In contrast, veterans receiving veteran peer motivational coaching achieved significantly greater improvements in depression, posttraumatic stress disorder and cannabis use scores, quality of life domains, and adoption of some self-care strategies than controls (secondary outcomes). Qualitative data revealed that veterans who received veteran peer motivational coaching may no longer have perceived a need for MH treatment.

Conclusions

Among veterans with MH problems using predominantly rural VA community clinics, telephone peer motivational coaching did not enhance MH treatment engagement, but instead had positive effects on MH symptoms, quality of life indicators, and use of self-care strategies.