Analysis indicates invariance over time in Information and Referral Line call volume, while Crisis Line call volume was highest during the intervention, increasing on a daily basis only during this time period. These findings provide evidence of a media effects process in which the dissemination of the media campaign invoked an increase in the suggested behavior (i.e., calling Via Link for help with matters such as stress and depression). This is an important finding, suggesting the potential mental health benefit of media campaigns in post-disaster settings that are fraught with threats to mental health. This finding is generally consistent with those of the previous study that involved a media campaign and use of a telephone hotline for mental health services following 9/11.11
A strength of the current study's approach is its measurement of help line call behavior with call center data and not via respondents' self-report, an approach that could have been implemented with survey data. Another evaluation of this media campaign relied on survey data, but considered the campaign recommendations for specific PTSD preventive behavior, not its recommendation of contacting Via Link for further assistance. That study found support for a multistep model in which campaign attention influenced PTSD beliefs, which influenced PTSD preventive behavior, which, in turn, inversely influenced PTSD.18
While the current analysis indicates that Crisis Line call volume increased following the dissemination of campaign messages recommending such calls, it is important to consider potential alternative explanations for the increase including: (1) that help line call volume would be generally expected to increase following the hurricane, free of the influence of the media campaign and, perhaps, as a result of the continued psychological effects of the hurricane; and (2) that Crisis Line call volume would be expected to increase on a consistent basis following the hurricane, free of the influence of the media campaign and, perhaps, related to the differing nature of the two help lines.
The first alternative explanation would entail that help line call volume, either via the Crisis Line or Information and Referral Line, would increase following the hurricane. If this were the case, it would undermine this study's determination of the media campaign's effectiveness. Such a general upward trend in help line call volume, however, is inconsistent with this study's demonstration that Information and Referral Line call volume did not vary among pre-intervention, intervention, and post-intervention. In contrast, Crisis Line call volume increased from pre-intervention to intervention. Thus, although Crisis Line call volume increased with the onset of the media campaign, Information and Referral Line call volume remained constant. This finding offers support for the media campaign's effectiveness, with its dissemination appearing to influence the behavior of calling the Crisis Line. Furthermore, there were no significant daily trends in Information and Referral Line call volume during pre-intervention, intervention, or post-intervention. In contrast, Crisis Line call volume increased at a significant daily rate during the intervention. That this rate was significant—in contrast with the daily rates of the Crisis Line at pre- or post-intervention and the Information and Referral Line at any of the three time periods—provides further support for the media campaign's effectiveness.
The second potential alternative explanation is that Crisis Line call volume would increase on a consistent basis following the hurricane, free of the influence of the media campaign and, perhaps, related to the differing nature of the two help lines. Such a consistent increase in Crisis Line call volume would undermine this study's determination of the media campaign's effectiveness. In such a scenario, differences in help line call volume could result from the differing nature of the two help lines. It is possible that there would be different trends in requests for basic assistance via the Information and Referral Line and requests for psychological assistance via the Crisis Line. Thus, it could be that the need for basic assistance remained constant, while the need for psychological assistance rose following the hurricane. This alternative explanation, however, does not hold up. The daily trend in Crisis Line call volume was constant during pre-intervention, steeply positive during intervention, and then negative during post-intervention. These trends indicate that there was a dramatic increase in Crisis Line call volume with the onset of the campaign intervention—and then a drop-off after the intervention.
It is important to consider such alternative explanations because of the difficulty of measuring the myriad potential influences in a study of this nature. The analysis conducted in this study helps mitigate such concerns and addresses the three primary elements of causation: (1
) that X and Y covary, (2
) that X precedes Y, and (3
) that the relationship between X and Y is not spurious.28