Characteristics of Telephone Crisis Hotline Callers with Suicidal Ideation in Japan

The impact of a telephone hotline on suicide attempts and self-injurious behaviors in patients with borderline personality disorder

Background

Borderline personality disorder is often associated with self-injurious behaviors that cause personal suffering, family distress, and substantial medical costs. Mental health hotlines exist in many countries and have been shown to be effective in some contexts, but none have been specifically designed for borderline patients. The aim of the present study is to evaluate the impact of a 24/7 hotline dedicated to patients with borderline personality disorder on suicide attempts and self-injurious behaviors.

Methods

We conducted a single-blind, multicenter (9 French centers) clinical trial with stratified randomization (by age, sex and center). Patients (N = 315) with a diagnosis of borderline personality disorder (according to the SIDP-IV) were randomized into two groups with or without access to the hotline in addition to treatment as usual. The number of suicide attempts and self-injurious behaviors in each group within 12 month were analyzed in the "per protocol" population (Student's t-tests, 5% significance threshold), adjusting for possible confounders in a multivariate analysis (using Poisson regression). The percentage of patients with suicide attempts and with self-injurious behaviors (and other percentages) were analyzed in the per protocol population (χ2-tests or exact Fischer tests, 5% significance threshold).

Results

The mean number of suicide attempts was 3 times lower in the hotline group (0.41 vs. 1.18, p = 0.005) and the mean number of self-injurious behaviors was 9 times lower (0.90 vs. 9.5, p = 0.006). Multivariate analysis confirmed the effectiveness of the hotline in reducing suicide attempts and self-harm.

Conclusion

This study supports the effectiveness of hotlines in reducing self-aggressive behavior in patients with borderline personality disorder. Such support is easy to use, cheap and flexible, and therefore easy to implement on a large scale.

Echoes in a "tree hole": A qualitative study on the service needs and responses at an antidrug helpline in China

INTRODUCTION

China's anti-drug measures have been slowly shifting from police-intervention and punitive approaches to supportive services. However, the system is still highly stigmatizing. Helpline services emerged to engage drug users, families, and friends and provide needed support as they seek rehabilitation. This study aimed to explore service needs expressed during helpline calls, operators' use of techniques when responding to different needs, and operators' experiences working at and views toward the helpline.

METHODS

We conducted a qualitative mixed-method study using two sources of data. One source was 47 call recordings collected at a drug helpline in China, and the other was five individual and two focus group interviews conducted with 18 helpline operators. Using a six-step thematic analysis method, we explored the patterns of needs expression and response, and the operators' experiences of interacting with callers.

RESULTS

We found that typical callers were drug users and their relatives or friends. Interactions between the callers and operators involved the expression of and response to needs that emerged from involvement with drugs. Informational and emotional needs were the most common. Operators would respond to these needs with different counseling techniques, such as providing information, advising, normalizing, focusing, and instilling hope. The operators developed a system of practices, such as internal supervision, case summaries, and listening back, to enhance competence and ensure quality of services. The helpline work also prompted their critical reflections on the current antidrug system and gradually reshaped their views toward the population they serve.

CONCLUSIONS

Antidrug workers who engaged in answering helpline calls employed varying techniques to facilitate callers' expressed needs. They helped by providing much-needed informational and emotional support for drug users, families, and friends. Helpline services opened a private channel for people involved in drug use to express their needs and seek formal help in China's still stigmatizing and punitive antidrug system. Experiences working with anonymous help-seekers outside the statutory rehabilitation system helped workers at the helpline to gain unique reflective insight into the antidrug system and drug users.

Factors Related to Psychological Distress in Suicide Prevention Supporters during the COVID-19 Pandemic

PURPOSE

Psychological distress and related factors in suicide prevention supporters during the COVID-19 pandemic were clarified.

METHODS

A web-based survey for supporters from helplines or psychiatric institutions was conducted from May to July 2021. It included items about profession, stress and anxiety, and the Kessler Psychological Distress Scale.

RESULTS

818 participants were analyzed. Psychological distress was significantly higher among healthcare workers in psychiatric institutions than among helpline volunteers. The factor most related to psychological distress in both professions was insufficient rest with overwork. Distress in helpline volunteers was related to their lack of ability to support people with suicidal thoughts and suicide attempts, excessive media coverage related to COVID-19, and trouble dealing with complainers. Distress in healthcare workers was related to their lack of ability to provide sufficient support to their clients due to infection prevention measures.

CONCLUSION

Psychological distress among suicide prevention supporters during the pandemic has been affected by overwork, the fact that helpline volunteers cannot be trained in suicide prevention, and the fact that healthcare workers can only provide insufficient support to their clients due to infection prevention measures. To maintain suicide prevention during pandemics, it is necessary to implement measures that are tailored to the factors of psychological distress in supporters.

Level of Suicidal Ideation Among Callers to the Danish Suicide Prevention Helpline

OBJECTIVE

The aim of this study was to: (1) determine the proportion of callers to a national helpline for suicide prevention who were evaluated to be at risk of suicide; (2) identify characteristics associated with being at risk; (3) determine the level of suicidal ideation among callers, as measured by a clinical scale, and compared to the general population.

METHOD

Data on all calls answered at the Danish helpline for suicide prevention during 2018-2019 were analyzed. These consisted of socio-demographic covariates and items related to suicidality, including the Suicidal Ideation Attribute Scale (SIDAS). Data on SIDAS for the general population derived from a survey. Being at risk of suicide, as evaluated by the counselors, was examined as outcome in adjusted logistic regressions.

RESULTS

Among 42,393 answered calls, 24,933 (59%) related to personal concerns. Of these, 47% and 14% of callers, respectively, had suicidal thoughts and concrete suicidal plans, while 53% were evaluated to be at risk. Higher risks were found when issues related to self-harm, mental health problems, eating disorders, incest, physical health problems, substance abuse, or sexual assault were mentioned. In all 37% of callers who were administered the SIDAS scale were evaluated to be at high risk of suicide compared to 1.5% in the general population.

CONCLUSIONS

A substantial share of callers to a national helpline for suicide prevention were evaluated to be at risk of suicide, also when using a clinical scale. This emphasizes the potential for counselors to prevent suicidal behavior.HighlightsMore than half of callers reaching out to the helpline were evaluated to be at risk of suicide, and 37% were identified as being at high risk using SIDAS, a clinical scale.Being woman, of younger age, having a history of previous suicide attempt as well as experiencing problems related to self-harm, mental disorders, sexual assault, substance abuse, and physical health problems was associated with risk of suicide, as evaluated by counselors.This seemingly is the first study to compare clinical scores of helpline callers to those of the general population and significantly higher levels of suicidal ideation were found among helpline callers.

The analysis of telephone consultation contents of patients with bipolar disorder received by a self-help group

Aim

Previous research shows that telephone consultation is useful in suicide prevention, substance use disorder, and other mental illnesses. However, no study has been conducted with a specific focus on telephone consultation for patients with bipolar disorder (BPD). Therefore, this study investigates the utilization of telephone consultation by patients with BPD and their families and analyzes the consultation contents to identify specific issues that they face.

Methods

We investigated a record book of telephone consultation conducted between 2013 and 2019 provided by the Japanese Alliance of Bipolar Disorder, which is a self-help group in Japan specializing in BPD. The main themes regarding consultation were extracted and labelled as diagnosis, symptoms, treatment, laws and social support, interpersonal relations, social life, other people with BPD, and others, with up to three items being labeled per consultation.

Results

A total of 3540 consultations were sought, and consulters who were patients accounted for 74% of the calls. The largest number of consultations were those related to symptoms (1522), followed by interpersonal relations (1003), social life (896), and treatment (797). There was a significant difference in the distribution of consultation contents between patients and their families (χ 2 = 44.595, p < 0.0001).

Conclusion

Most consultations by patients with BPD were about their psychiatric symptoms. Consultation contents differed between patients and families, with patients focusing more on their own social life and families focusing more on the treatment of BPD. These findings could help health-care professionals in formulating effective psychoeducation and psychotherapy programs.

Gender differences in use of suicide crisis hotlines: a scoping review of current literature

Purpose

Little is known about the gender profile of callers to crisis hotlines, despite distinct gender differences in suicide risk and behavior. The authors assessed current knowledge of the role of caller gender in the use of crisis hotlines for suicide, specifically whether there are differences in frequency, reason for call and caller outcomes by gender.

Design/methodology/approach

The authors conducted a scoping literature review of peer-reviewed studies published since 2000 in Medline, PubMed and PsychInfo, examining a total of 18 articles based on 16 studies.

Findings

Overall, women represent a higher percentage of calls to crisis hotlines worldwide, despite men having higher rates of suicide. Primary reasons for calling hotlines were the same for men and women, regardless of geography or culture. When gender differences in reason for call were reported, they were consistent with literature documenting gender differences in the prevalence of risk factors for suicide, including higher rates of substance use among men and higher instances of domestic violence/abuse among women.

Research limitations/implications

There was variability in the studies the authors examined. This review was limited to research on crisis telephone hotlines and did not include text or chat services. Due to data reporting, the findings are constrained to reporting on a male/female gender binary.

Originality/value

Findings on gender differences in crisis line use suggest a need for continued research in this area to determine how to best meet the needs of callers of all genders.

Crisis line services: A 12-month descriptive analysis of callers, call content, and referrals

Crisis lines are a valuable community resource that anonymously and freely serve those in acute crisis. As a result of anonymity, it has been difficult to fully characterise crisis line services. However, appraising and improving crisis line services for the communities they serve is essential, even with the additional difficulty anonymity poses. This study seeks to increase our understanding of current crisis services and utilisation via a characterisation of various aspects of a United States crisis line service centre over 12-months including features of calls (e.g. call length), callers (e.g. victimisation history), and information provided to the caller (e.g. referrals). We examine five crisis lines totalling 5,001 calls from October 2018 to September 2019. Descriptive information is provided on call volume, patterns across time, caller characteristics, victimisation types, and referrals. Although we were unable to assess prospective outcomes due to anonymity, 99.5% of callers that were asked (61.35% of all calls; n = 3,068) reported the call as helpful. This provides an important overview of crisis line services and suggests they are a valuable community health resource serving a range of callers. Given the findings of the present study, we conclude with a discussion of recommendations and implications for community crisis line centres and future research.

Analysing the Impacts of Financial Support for Regional Suicide Prevention Programmes on Suicide Mortality Caused by Major Suicide Motives in Japan Using Statistical Government Data

To improve and plan regional suicide prevention programmes that utilise more cost-effective governmental financial support compared with previous programmes, the present study determined the effects of the amount of financial support provided for regional suicide prevention programmes, such as the Emergency Fund to Enhance Community-Based Suicide Countermeasures (EFECBSC), on the trends of suicide mortalities caused by six major suicide motives between 2009 and 2018, using forward multiple regression analysis. The ranking order of motives for male suicide was health, economy, family, employment, romance and school (in that order), whereas the ranking order for females was health, family, economy, romance, employment and school. Male suicide mortality caused by economy-related motives was significantly/inversely related to prefectural intervention programmes, whereas mortality caused by health-related motives was also significantly/inversely related to prefectural intervention programmes, but significantly/positively related to prefectural personal consultation support programmes. Contrary to males, female suicide mortality caused by health-related motives was significantly/inversely related to the municipal development programmes of leaders/listeners, whereas mortality caused by family- and school-related motives was significantly/positively related to prefectural and municipal telephone consultation support programmes, respectively. Contrary to our expectations, school-aged female suicide mortality caused by school-related motives was significantly/positively related to prefectural personal consultation support, enlightenment and municipal telephone consultation support programmes. These results indicate that Japanese regional suicide prevention programmes probably affect the suppression of male suicide mortality. However, these programmes are possibly ineffective, or at least partially, have an adverse effect, in regard to the suicide mortalities of female and school-aged populations. Therefore, we should work to improve regional suicide prevention programmes, making them more cost-effective and targeted towards female and school-aged populations in the future.

Comparisons of Characteristics Between Psychological Support Hotline Callers With and Without COVID-19 Related Psychological Problems in China

Background: To compare the characteristics between hotline callers with and without the Coronavirus Disease 2019 (COVID-19) related psychological problems. Methods: From January 25 to March 31, 2020, 581 callers with COVID-19 related psychological problems (COVID-19 callers) and 695 callers without COVID-19 related psychological problems (non-COVID-19 callers) to the Beijing Psychological Support Hotline were recruited. The demographic characteristics, primary concerns, suicidal ideation, depression and other psychological problems were compared between the two groups of callers. Results: Both groups of the callers were predominantly female and highly educated. The primary concerns reported by the COVID-19 callers were depression (38.4%) and family relationship problems (26.0%). As compared to the non-COVID-19 callers, COVID-19 callers reported more financial (7.4%) and work related problems (4.1%), but revealed lower prevalence of suicidal ideation (47.9% v 71.3%), lower degrees of psychological distress (74.3 v 79.1), intensity of suicidal ideation (0 v 50), severity of depression (57.9 v 65.1), and higher degree of hopefulness (41.1 v 33.6) (all p values < 0.01). Additionally, a lower proportion of COVID-19 callers met the criteria of depressed mood (51.6% v 61.4%) and other 4 symptoms than the non-COVID-19 callers (p values < 0.01). Conclusions: Based on the content of the primary concerns and the relatively low level of depression of the COVID-19 callers, the psychological intervention for them during the pandemic should focus on "psychological supports." Coping strategies for daily life stressors and promotion of scientific knowledge about the pandemic should also be included in the hotline-related interventions.

Engagement With Crisis Text Line Among Subgroups of Users Who Reported Suicidality

OBJECTIVE

Despite the interest in technology-enhanced preventive interventions for suicidality, there is minimal peer-reviewed research on conversations of text message hotlines. In this large-scale study, the authors explored distinct classes of users of the Crisis Text Line who reported suicidality. Classes were based on texters' presenting psychosocial issues and were explored across frequency of hotline use and conversation number.

METHODS

Data included 153,514 conversations from 122,909 individuals collected by the Crisis Text Line (2013-2017). Analyses were restricted to conversations from users who mentioned current or previous suicidality and excluded texters who discussed a third party. The authors used latent class analysis to identify distinct classes of texters on the basis of crisis counselor-assigned issue tags and across subgroups reflecting whether the conversation was the first or last contact with the hotline and frequency of use (one-time, two-time, or ≥3-time texters).

RESULTS

Three classes emerged in all subsamples. The largest class, "lower distress," had the lowest prevalence of all issues. The second largest class, "anxious distress," had the highest prevalence of anxiety or stress and elevated depression. The smallest class, "relational distress," had the highest prevalence of depression and self-harm and higher probability of endorsing relational indicators.

CONCLUSIONS

Psychological and relational issues mostly distinguished the three classes. Despite differing frequency of hotline usage, most texters who reported suicidal ideation and behaviors endorsed similar issues, and these issues did not seem to vary across conversations. Yet there appeared to be distinct subgroups of texters with different presenting issues, which may inform how crisis counselors tailor strategies for both low- and high-volume texters.

[Are suicidal young people reached by online-counselling? Evaluation of the target group outreach of [U25] online suicide prevention]

Are suicidal young people reached by online-counselling? Evaluation of the target group outreach of [U25] online suicide prevention Abstract. Objective: "[U25] Germany" is an online-counselling platform designed to help adolescents and young adults suffering from suicidal ideation or emotional crisis. The online approach and anonymous counselling by peers (young voluntary workers) instead of professionals were initiated to lower the threshold for those seeking help. This study examines characteristics of people seeking help from [U25] and estimates the outreach of the program. Method: Data from n = 1062 counselling protocols dating from 2017 were obtained. In addition, we conducted n = 13 problem-focused interviews with peer counsellors. Results: Our data indicate a good target group outreach concerning age, suicidality, and psychological burden of the clients. However, young men seek counselling by [U25] less frequently than young women. Additionally, preliminary data indicate that young people with lower educational background consult [U25] less often. Conclusions: [U25] offers a promising approach to helping young people suffering from suicidal ideation or a personal crisis. New approaches should be developed and evaluated to better reach young men and persons with a lower education background.

Gender Differences in Risk Factors Related to Suicidal Ideation Among Callers to Telephone Helplines in Spain

The main goals of this study were to determine the prevalence rate of suicidal ideation among callers to a Spanish telephone general crisis helpline (Teléfono de la Esperanza) and to identify gender-based characteristics and risk factors related to suicidal ideation. A sample of 10,765 (6,868 men and 3,897 women) callers to this telephone helpline was assessed. ATENSIS, an assessment tool designed to collect information related to suicidal ideation among callers to telephone helplines, was used. Comparisons between men and women with suicidal ideation were carried out in all variables studied: sociodemographics, telephone call timing, risk factors, and suicidality. Of the total sample, 1.87% (n = 201) presented suicidal ideation, with a higher prevalence in women (2.80%) than in men (1.34%). Moreover, significant gender-based differences among callers with suicidal ideations were observed in some variables: women were older than men and showed a greater prevalence of chronic disease with pain; men showed a greater prevalence of depression, alcohol/drug abuse, helplessness, and lack of hope for the future. This study showed that telephone helplines can be used to identify suicidal ideation among callers. Moreover, gender-based differential characteristics among suicide ideators have been found. The implications for further research are discussed.

Relationship between suicidal ideation and family problems among young callers to the Japanese crisis hotline

Previous studies have reported an association between family relationships and suicidal behavior, and found that people with high suicidal ideation are not likely to consult with others about their distress. An effective consulting service is therefore necessary for such individuals. Crisis hotlines are effective for reducing suicide risk, but their associated suicide ideation rate and odds ratio of family problems children remain unclear. The present study investigated the suicidal ideation rate and odds ratio of callers under 20 years of age (N = 24,333) with family problems to the Japanese crisis hotline in 2012. There were 5,242 (21.5%), 18,061 (74.2%), and 1,030 (4.2%) calls related to family problems, other problems, and both, respectively. The suicidal ideation rate and odds ratio of callers with family problems were 2.2% and 0.426, respectively. This result suggested that callers with family problems have a significantly lower rate and odds ratio for suicidal ideation compared with others. However, some associations with a high suicide ideation rate were found for individual items among callers with family problems such as abuse (20.4%), family breakdown (16.1%), and domestic violence (10.6%). Further studies are needed to understand the suicidal ideation of callers with family problems and develop more effective preventive strategies.

An evaluation of suicide prevention hotline results in Taiwan: Caller profiles and the effect on emotional distress and suicide risk

BACKGROUND

Hotlines are among commonly available and recommended suicide prevention strategies in many countries, but only a few empirical studies have focused on people who used this service and the proximal outcomes of calls made to the hotlines. This study is designed to investigate the demographic characteristics of the Taiwan National Suicide Prevention Hotline (NSPH) callers and whether the NSPH service helps to alleviate the callers' emotional distress and suicide risk.

METHODS

Descriptive statistics were used to describe the gender, age and county/city distribution of the 63,696 callers from 2009 to 2011. Three hundred telephone records of 100 acute suicidal callers, 100 suicidal callers, and 100 non-suicidal callers were then randomly selected for further investigation of the proximal changes in the callers' emotional disturbance and suicidality.

RESULTS

Notwithstanding the suicide status of the callers, significant decreases in their emotional distress and suicidality could be detected during the course of the telephone session. Men, the elderly, and people living outside northern Taiwan, however, were less likely to call the NSPH. An unexpected yet significant finding is that people with an ongoing suicide attempt were less emotionally distressed than those with only suicidal thoughts.

CONCLUSIONS

The hotline is a useful suicide preventive and crisis intervention service. However, further creative and consistent work is needed to make the service more appealing to the hard-to-reach population.