1
|
Draper J, McKeon RT. The Journey Toward 988: A Historical Perspective on Crisis Hotlines in the United States. Psychiatr Clin North Am 2024; 47:473-490. [PMID: 39122341 DOI: 10.1016/j.psc.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
This article reviews the historical trajectory of crisis hotlines in the United States from their 1960's inception as 24/7 alternatives to traditional mental health services to becoming "the front door" of the 988 Suicide and Crisis Lifeline in 2022. The Substance Abuse and Mental Health Services Administration's (SAMHSA's) 2001 effort to network, certify, and evaluate crisis hotlines laid the foundation for demonstrating the efficacy of crisis hotlines and their ability to reduce distress and suicidality in people accessing these services. SAMHSA-funded evaluations and the collective leadership of the National Suicide Prevention Lifeline network established evidence-based standards, policies, and practices.
Collapse
Affiliation(s)
- John Draper
- Behavioral Health Link, Inc, 7423 Narrows Avenue, Brooklyn, NY 11209, USA.
| | - Richard T McKeon
- Center for Mental Health Services, SAMHSA, 988 and Behavioral Health Crisis Coordinating Office, 5600 Fishers Ln, Rockville, MD 20852, USA
| |
Collapse
|
2
|
Foster AA, Zabel M, Schober M. Youth Crisis: The Current State and Future Directions. Psychiatr Clin North Am 2024; 47:595-611. [PMID: 39122348 DOI: 10.1016/j.psc.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
The number of children and youth experiencing behavioral health crisis in the United States is substantially increasing. Currently, there are shortages to home-based and community-based services as well as psychiatric outpatient and inpatient pediatric care, leading to high emergency department utilization. This article introduces a proposed crisis continuum of care, highlights existing evidence, and provides opportunities for further research and advocacy.
Collapse
Affiliation(s)
- Ashley A Foster
- Department of Emergency Medicine, University of California, San Francisco, 550 16th Street, Box 0649, San Francisco, CA 94143, USA.
| | - Michelle Zabel
- Innovations Institute, University of Connecticut School of Social Work, 38 Prospect Street, Hartford, CT 06103, USA
| | - Melissa Schober
- Innovations Institute, University of Connecticut School of Social Work, 38 Prospect Street, Hartford, CT 06103, USA
| |
Collapse
|
3
|
Glenn CR, Kalgren T, Dutta S, Kandlur R, Allison KK, Duan A, Eskin CK, Leets M, Gould MS. Evaluating the Experience of Teen-to-Teen Crisis Line Volunteers: A Pilot Study. Community Ment Health J 2024:10.1007/s10597-024-01298-z. [PMID: 38833081 DOI: 10.1007/s10597-024-01298-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 05/15/2024] [Indexed: 06/06/2024]
Abstract
Teen-to-teen (t2t) crisis lines are a special type of crisis service where youth volunteers help their peers. Although prior research has examined the experience of adult crisis line responders, no research has examined the experience of adolescents who do this work. In collaboration with two of the largest t2t lines in the U.S., this pilot study is the first examination of t2t crisis line work. Volunteers (ages 14-20) reported: their primary motivation for joining the crisis lines was to help others and give back to the community; responding to a range of peers' problems on the t2t crisis line, including high-risk suicide contacts; and a range of ways the crisis line work impacted their lives. Findings provide preliminary information about the experience of adolescents engaging in t2t crisis line work. Additional research is needed in larger and more diverse samples to understand the impact of crisis line work for youth.
Collapse
Affiliation(s)
- Catherine R Glenn
- Old Dominion University, Norfolk, VA, USA.
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA.
| | | | | | - Raksha Kandlur
- Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| | | | - Annie Duan
- University of Rochester, Rochester, NY, USA
| | | | | | | |
Collapse
|
4
|
Xu Y, Chan CS, Chan E, Chen J, Cheung F, Xu Z, Liu J, Yip PSF. Tracking and Profiling Repeated Users Over Time in Text-Based Counseling: Longitudinal Observational Study With Hierarchical Clustering. J Med Internet Res 2024; 26:e50976. [PMID: 38815258 PMCID: PMC11176871 DOI: 10.2196/50976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/14/2023] [Accepted: 04/12/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Due to their accessibility and anonymity, web-based counseling services are expanding at an unprecedented rate. One of the most prominent challenges such services face is repeated users, who represent a small fraction of total users but consume significant resources by continually returning to the system and reiterating the same narrative and issues. A deeper understanding of repeated users and tailoring interventions may help improve service efficiency and effectiveness. Previous studies on repeated users were mainly on telephone counseling, and the classification of repeated users tended to be arbitrary and failed to capture the heterogeneity in this group of users. OBJECTIVE In this study, we aimed to develop a systematic method to profile repeated users and to understand what drives their use of the service. By doing so, we aimed to provide insight and practical implications that can inform the provision of service catering to different types of users and improve service effectiveness. METHODS We extracted session data from 29,400 users from a free 24/7 web-based counseling service from 2018 to 2021. To systematically investigate the heterogeneity of repeated users, hierarchical clustering was used to classify the users based on 3 indicators of service use behaviors, including the duration of their user journey, use frequency, and intensity. We then compared the psychological profile of the identified subgroups including their suicide risks and primary concerns to gain insights into the factors driving their patterns of service use. RESULTS Three clusters of repeated users with clear psychological profiles were detected: episodic, intermittent, and persistent-intensive users. Generally, compared with one-time users, repeated users showed higher suicide risks and more complicated backgrounds, including more severe presenting issues such as suicide or self-harm, bullying, and addictive behaviors. Higher frequency and intensity of service use were also associated with elevated suicide risk levels and a higher proportion of users citing mental disorders as their primary concerns. CONCLUSIONS This study presents a systematic method of identifying and classifying repeated users in web-based counseling services. The proposed bottom-up clustering method identified 3 subgroups of repeated users with distinct service behaviors and psychological profiles. The findings can facilitate frontline personnel in delivering more efficient interventions and the proposed method can also be meaningful to a wider range of services in improving service provision, resource allocation, and service effectiveness.
Collapse
Affiliation(s)
- Yucan Xu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | | | - Evangeline Chan
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Junyou Chen
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Florence Cheung
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Zhongzhi Xu
- School of Public Health, Sun Yat-sen University, Guang Zhou, China
| | - Joyce Liu
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Paul Siu Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China (Hong Kong)
| |
Collapse
|
5
|
Schwab-Reese L, Short C, Jacobs L, Fingerman M. Rapport Building in Written Crisis Services: Qualitative Content Analysis. J Med Internet Res 2024; 26:e42049. [PMID: 38748472 PMCID: PMC11137431 DOI: 10.2196/42049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 08/21/2023] [Accepted: 03/26/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Building therapeutic relationships and social presence are challenging in digital services and maybe even more difficult in written services. Despite these difficulties, in-person care may not be feasible or accessible in all situations. OBJECTIVE This study aims to categorize crisis counselors' efforts to build rapport in written conversations by using deidentified conversation transcripts from the text and chat arms of the National Child Abuse Hotline. Using these categories, we identify the common characteristics of successful conversations. We defined success as conversations where help-seekers reported the hotline was a good way to seek help and that they were a lot more hopeful, a lot more informed, a lot more prepared to address the situation, and experiencing less stress, as reported by help-seekers. METHODS The sample consisted of transcripts from 314 purposely selected conversations from of the 1153 text and chat conversations during July 2020. Hotline users answered a preconversation survey (ie, demographics) and a postconversation survey (ie, their perceptions of the conversation). We used qualitative content analysis to process the conversations. RESULTS Active listening skills, including asking questions, paraphrasing, reflecting feelings, and interpreting situations, were commonly used by counselors. Validation, unconditional positive regard, and evaluation-based language, such as praise and apologies, were also often used. Compared with less successful conversations, successful conversations tended to include fewer statements that attend to the emotional dynamics. There were qualitative differences in how the counselors applied these approaches. Generally, crisis counselors in positive conversations tended to be more specific and tailor their comments to the situation. CONCLUSIONS Building therapeutic relationships and social presence are essential to digital interventions involving mental health professionals. Prior research demonstrates that they can be challenging to develop in written conversations. Our work demonstrates characteristics associated with successful conversations that could be adopted in other written help-seeking interventions.
Collapse
Affiliation(s)
- Laura Schwab-Reese
- Department of Public Health, Purdue University, West Lafayette, IN, United States
| | - Caitlyn Short
- Department of Public Health, Purdue University, West Lafayette, IN, United States
| | | | | |
Collapse
|
6
|
Iversen C, Westerlund M. Users' Perspectives on Crisis Helplines in Relation to Professional Mental Health Services. CRISIS 2024; 45:173-179. [PMID: 35983720 PMCID: PMC11063977 DOI: 10.1027/0227-5910/a000876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 06/16/2022] [Accepted: 06/24/2022] [Indexed: 11/23/2022]
Abstract
Background: Crisis helplines aim to provide a short-term intervention or guide users to professional mental health services, but many users return to helplines despite having professional mental health contacts. Aims: To contribute knowledge on users' perspectives on the role of crisis helplines in relation to their professional mental health contacts, we aimed to investigate how online helpline users describe such services. Methods: We used thematic analysis of 100 naturally occurring interactions from a Swedish online crisis helpline. Results: The users viewed the helpline as a safe space, a partner, or an alternative to bad professional services. Users oriented to ongoing helpline usage as crucial for their well-being while they described using professional mental health services to be able to stay alive. Limitations: The findings are limited to the nature of the different themes. Conclusion: The view on crisis helplines as a short-term intervention relies on an idealized view on crisis intervention that does not represent users' views. User control is at the core of the appeal of helplines, but it is also a key challenge for organizations and volunteers.
Collapse
Affiliation(s)
- Clara Iversen
- Centre for Social Work, Department of Sociology, Uppsala University, Sweden
| | - Michael Westerlund
- Department of Media Studies, Stockholm University, Sweden
- National Centre for Suicide Research and Prevention (NASP), Department of Learning, Informatics, Management and Ethics, Stockholm Health Care Services, Sweden
| |
Collapse
|
7
|
Ward CE, Badolato GM, Taylor MF, Brown KM, Simpson JN, Chamberlain JM. Prevalence of Low-Acuity Pediatric Emergency Medical Services Transports to a Pediatric Emergency Department in an Urban Area. Pediatr Emerg Care 2024; 40:347-352. [PMID: 38355133 PMCID: PMC11096070 DOI: 10.1097/pec.0000000000003131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
OBJECTIVES Many patients transported by Emergency Medical Services (EMS) do not have emergent resource needs. Estimates for the proportion of pediatric EMS calls for low-acuity complaints, and thus potential candidates for alternative dispositions, vary widely and are often based on physician judgment. A more accurate reference standard should include patient assessments, interventions, and dispositions. The objective of this study was to describe the prevalence and characteristics of low-acuity pediatric EMS calls in an urban area. METHODS This is a prospective observational study of children transported by EMS to a tertiary care pediatric emergency department. Patient acuity was defined using a novel composite measure that included physiologic assessments, resources used, and disposition. Bivariable and multivariable logistic regression were conducted to assess for factors associated with low-acuity status. RESULTS A total of 996 patients were enrolled, of whom 32.9% (95% confidence interval, 30.0-36.0) were low acuity. Most of the sample was Black, non-Hispanic with a mean age of 7 years. When compared with adolescents, children younger than 1 year were more likely to be low acuity (adjusted odds ratio, 3.1 [1.9-5.1]). Patients in a motor vehicle crash were also more likely to be low acuity (adjusted odds ratio, 2.4 [1.2-4.6]). All other variables, including race, insurance status, chief complaint, and dispatch time, were not associated with low-acuity status. CONCLUSIONS One third of pediatric patients transported to the pediatric emergency department by EMS in this urban area are for low-acuity complaints. Further research is needed to determine low-acuity rates in other jurisdictions and whether EMS providers can accurately identify low-acuity patients to develop alternative EMS disposition programs for children.
Collapse
Affiliation(s)
| | - Gia M Badolato
- From the Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Michael F Taylor
- From the Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | | | | | | |
Collapse
|
8
|
Baker M, Sorensen J. The 988 suicide hotline-Lifeline or letdown? A pre-post policy analysis. Front Public Health 2024; 12:1337362. [PMID: 38694977 PMCID: PMC11061396 DOI: 10.3389/fpubh.2024.1337362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/26/2024] [Indexed: 05/04/2024] Open
Abstract
Suicide has emerged as an urgent threat in recent years as COVID-19 impaired the health and economic wellbeing of millions of Americans. According to the Centers for Disease Control and Prevention, the impact of COVID-19 and the ongoing opioid epidemic has "taken a mental, emotional, physical, and economic toll on individuals, families, and communities," increasing the need for innovative solutions to prevent suicide on a national scale. The National Suicide Hotline Designation Act of 2020 established 988 as the universal telephone number for suicide prevention and represents a key federal intervention to address this crisis. However, research on 9-8-8's effectiveness is limited, given the Act's recent enactment and implementation at the federal and state levels. This policy analysis investigates how and to what extent the mental health crisis system in Georgia has improved since the implementation of the 2020 Act as well as the implications of state law on population-level mental health outcomes. Georgia is used as a nationally representative case study for two reasons: (1) Georgia had a robust statewide suicide hotline prior to 2020, providing solid infrastructure on which federal expansion of a suicide hotline number could be built, and (2) the conflicting characteristics of Georgia's mental health system represent several different pockets of the U.S., allowing this analysis to apply to a broad range of states and locales. The paper draws on takeaways from Georgia to propose state and national policy recommendations for equitable interventions to prevent and respond to this form of violence.
Collapse
Affiliation(s)
- Michaella Baker
- Pritzker School of Law, Northwestern University, Chicago, IL, United States
| | | |
Collapse
|
9
|
Côté LP, Lane J. Evaluation of the Effectiveness of Suicide.ca, Quebec's Digital Suicide Prevention Strategy Platform: Cross-Sectional Descriptive Study. JMIR Form Res 2024; 8:e46195. [PMID: 38446536 PMCID: PMC10955392 DOI: 10.2196/46195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/07/2023] [Accepted: 12/04/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND In 2017, the Quebec government assigned the Association québécoise de prévention du suicide (AQPS) to develop a digital suicide prevention strategy (DSPS). The AQPS responded by creating a centralized website that provides information on suicide and mental health, identifies at-risk individuals on the internet, and offers direct crisis intervention support via chat and text. OBJECTIVE This study aims to evaluate the effectiveness of suicide.ca, Quebec's DSPS platform. METHODS This study used a cross-sectional descriptive design. The study population comprised internet users from Quebec, Canada, who visited the suicide.ca platform between October 2020 and October 2021. Various data sources, such as Google Analytics, Firebase Console, and Customer Relation Management data, were analyzed to document the use of the platform. To understand the profile of suicide.ca users, frequency analyses were conducted using data from the self-assessment module questionnaires, the intervention service's triage questionnaire, and the counselors' intervention reports. The effectiveness of the platform's promotional activities on social media was assessed by examining traffic peaks. Google Analytics was used to evaluate the effectiveness of AQPS' strategy for identifying at-risk internet users. The impact of the intervention service was evaluated through an analysis of counselors' intervention reports and postintervention survey results. RESULTS The platform received traffic from a diverse range of sources, with promotional efforts on social media directly contributing to the increased traffic. The requirement of a user account posed a barrier to the use of the mobile app, and a triage question that involved personal information led to a substantial number of dropouts during the intervention service triage. AdWords campaigns and fact sheets addressing suicide risk factors played a crucial role in driving traffic to the platform. With regard to the profile of suicide.ca users, the findings revealed that the platform engaged individuals with diverse levels of suicidal risk. Notably, users of the chat service displayed a higher suicide risk than those who used the self-assessment module. Crisis chat counselors reported a positive impact on approximately half of the contacts, and overall, intervention service users expressed satisfaction with the support they received. CONCLUSIONS A centralized digital platform can be used to implement a DSPS, effectively reaching the general population, individuals with risk factors for suicide, and those facing suicidal issues.
Collapse
Affiliation(s)
- Louis-Philippe Côté
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-life practices, Université du Québec à Montréal, Montreal, QC, Canada
| | - Julie Lane
- Centre RBC d'expertise universitaire en santé mentale, Université de Sherbrooke, Sherbrooke, QC, Canada
| |
Collapse
|
10
|
Efe Z, Baldofski S, Kohls E, Eckert M, Saee S, Thomas J, Wundrack R, Rummel-Kluge C. Linguistic Variables and Gender Differences Within a Messenger-Based Psychosocial Chat Counseling Service for Children and Adolescents: Cross-Sectional Study. JMIR Form Res 2024; 8:e51795. [PMID: 38214955 PMCID: PMC10818237 DOI: 10.2196/51795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/29/2023] [Accepted: 11/29/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Text messaging is widely used by young people for communicating and seeking mental health support through chat-based helplines. However, written communication lacks nonverbal cues, and language usage is an important source of information about a person's mental health state and is known to be a marker for psychopathology. OBJECTIVE The aim of the study was to investigate language usage, and its gender differences and associations with the presence of psychiatric symptoms within a chat counseling service for adolescents and young adults. METHODS For this study, the anonymized chat content of a German messenger-based psychosocial chat counseling service for children and adolescents ("krisenchat") between May 2020 and July 2021 was analyzed. In total, 661,131 messages from 6962 users were evaluated using Linguistic Inquiry and Word Count, considering the following linguistic variables: first-person singular and plural pronouns, negations, positive and negative emotion words, insight words, and causation words. Descriptive analyses were performed, and gender differences of those variables were evaluated. Finally, a binary logistic regression analysis examined the predictive value of linguistic variables on the presence of psychiatric symptoms. RESULTS Across all analyzed chats, first-person singular pronouns were used most frequently (965,542/8,328,309, 11.6%), followed by positive emotion words (408,087/8,328,309, 4.9%), insight words (341,460/8,328,309, 4.1%), negations (316,475/8,328,309, 3.8%), negative emotion words (266,505/8,328,309, 3.2%), causation words (241,520/8,328,309, 2.9%), and first-person plural pronouns (499,698/8,328,309, 0.6%). Female users and users identifying as diverse used significantly more first-person singular pronouns and insight words than male users (both P<.001). Negations were significantly more used by female users than male users or users identifying as diverse (P=.007). Similar findings were noted for negative emotion words (P=.01). The regression model of predicting psychiatric symptoms by linguistic variables was significant and indicated that increased use of first-person singular pronouns (odds ratio [OR] 1.05), negations (OR 1.11), and negative emotion words (OR 1.15) was positively associated with the presence of psychiatric symptoms, whereas increased use of first-person plural pronouns (OR 0.39) and causation words (OR 0.90) was negatively associated with the presence of psychiatric symptoms. Suicidality, self-harm, and depression showed the most significant correlations with linguistic variables. CONCLUSIONS This study highlights the importance of examining linguistic features in chat counseling contexts. By integrating psycholinguistic findings into counseling practice, counselors may better understand users' psychological processes and provide more targeted support. For instance, certain linguistic features, such as high use of first-person singular pronouns, negations, or negative emotion words, may indicate the presence of psychiatric symptoms, particularly among female users and users identifying as diverse. Further research is needed to provide an in-depth look into language processes within chat counseling services.
Collapse
Affiliation(s)
- Zeki Efe
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Sabrina Baldofski
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Elisabeth Kohls
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, University Leipzig Medical Center, Leipzig University, Leipzig, Germany
| | | | | | | | - Richard Wundrack
- Krisenchat gGmbH, Berlin, Germany
- Department of Psychology, Chair of Personality Psychology, Humboldt Universität zu Berlin, Berlin, Germany
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, University Leipzig Medical Center, Leipzig University, Leipzig, Germany
| |
Collapse
|
11
|
Harris BR. Helplines for Mental Health Support: Perspectives of New York State College Students and Implications for Promotion and Implementation of 988. Community Ment Health J 2024; 60:191-199. [PMID: 37351714 DOI: 10.1007/s10597-023-01157-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
Mental health and suicide are serious concerns in the U.S. Though many adults report struggling with their mental health, a significant proportion do not receive care for various reasons including stigma, limited availability, long wait times, inability to pay, and a lack of culturally appropriate options. Helplines can be used to fill gaps in care and, though currently underutilized, are a significant focus of the federal government in the implementation of 988. To better understand the factors that facilitate and impede the utilization of helplines, we conducted 14 focus groups with 95 college students attending a public university and two private colleges in upstate New York between April 2019 and October 2020. Participants included undergraduates, graduate students, LGBTQIA + students, student-athletes, and international students. Participants shared several reasons for using helplines including convenience, comfort, immediate support, and privacy and anonymity. On the other hand, participants expressed hesitation as they expected ingenuine interactions with operators and a lack of continuity, they feared police involvement, and they felt that helplines are not for them, as they are marketed for those in a mental health or suicide crisis and their issues are not that severe. LGBTQIA + participants provided additional reasons as to why they use and do not use LGBTQIA+-specific helplines. Together, our findings suggest the need for improved education, marketing, and training around helplines and may be used to inform the implementation and promotion of 988 in its early stages.
Collapse
Affiliation(s)
- Brett R Harris
- Public Health Research Department, NORC at the University of Chicago, 4350 East-West Highway, 8th Floor, 20814, Bethesda, MD, USA.
- Department of Health Policy, Management and Behavior, University at Albany School of Public Health, One University Place, 12144, Rensselaer, NY, USA.
| |
Collapse
|
12
|
Sueki H, Takahashi A, Ito J. Changes in Suicide Ideation Among Users of Online Gatekeeping Using Search-Based Advertising. Arch Suicide Res 2023; 27:1339-1350. [PMID: 36237123 DOI: 10.1080/13811118.2022.2131491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Recently, the practice of "online gatekeeping" related to suicide prevention-placing online advertisements directed at users who search the web for suicide-related terms and leading them to email-based consultations-has been implemented. However, the effectiveness of this practice has not been examined. Therefore, we quantitatively examined the effectiveness of suicide-related online gatekeeping. This was a non-randomized, single-arm study of online gatekeeping among Japanese Internet users. Outcomes were measured at the beginning of the use of the consultation service (T1) and approximately four weeks later (T2). The primary outcome measured was suicidal ideation. In total, 167 participants completed two assessment surveys; approximately 80% were women, and 59.3% were young people (in their twenties or younger). Data analysis of 167 online gatekeeping service users showed that the mean suicidal ideation at T2 was statistically significantly lower than that at T1, and its effect size was small to medium (d = 0.37, 95% confidence interval: 0.15-0.59). Online gatekeeping is a promising suicide-prevention tool, although further research is warranted to examine its effectiveness using a randomized controlled trial.HighlightsWe examined the effectiveness of email-based consultations for suicide prevention.About 4 weeks later, users' suicidal ideation was significantly reduced (d = 0.37).This was a single-arm study and requires a more rigorous study design in the future.
Collapse
|
13
|
Efe Z, Baldofski S, Eckert M, Guenthner L, Saee S, Thomas J, Wundrack R, Kohls E, Rummel-Kluge C. Who are frequent chatters? Characterization of frequent users in a 24/7 messenger-based psychological chat counseling service for children and adolescents. Internet Interv 2023; 33:100638. [PMID: 37361028 PMCID: PMC10285518 DOI: 10.1016/j.invent.2023.100638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
Background Online helplines have shown a high acceptance, feasibility, and usability, especially with young people. Helplines usually aim to provide one-time crisis intervention; however, there are users who frequently use such services, tying a disproportionately large proportion of service capacities. To date, there is no research on the characterization of frequent users of online helplines. Therefore, the aim of the present study is to characterize frequent chatters in a chat-based counseling context. Methods This cross-sectional study retrospectively analyzed anonymous data of users who approached the German messenger-based psychological chat counseling service krisenchat between May 2020 and July 2021 (N = 6657), with a focus on frequent users - the "frequent chatters". Frequent chatters were defined as those who received an above average (M + 2 ∗ SD) amount of messages from counselors over a period of one week and had at least 7 days of contact with the service over the entire data collection period. Chi-square-tests and Mann-Whitney-U tests were conducted to identify differences between frequent users and the population of all users. Results In total, n = 99 (1.5 %) users met the definition for frequent chatters and accounted for roughly a tenth (9.85 %) of all chats of the service. The mean frequent chatter was 17 years old (M = 17.29, SD = 3.56), female (n = 78, 82.1 %), and approached the service in the late afternoon (M = 5:00 pm, SD = 5:25 h). Compared to the general user population, frequent chatters reported significantly more severe concerns to counselors, of which 81.8 % included psychiatric symptoms, such as suicidality (43.4 %) and non-suicidal self-injury (41.4 %). In addition, frequent chatters were significantly more likely to contact krisenchat alongside the use of other professional help services. Further, frequent chatters wrote significantly longer and more messages during the counseling process and within a session than the general user population of krisenchat. Compared to the general user population, frequent chatters did not differ in their satisfaction with the service. Conclusion Frequent users are known from telephone helplines and are also represented in a chat-based context. Compared to the general user population, they are more likely to report serious mental health conditions and half of them currently receive professional help, suggesting a high need for social support. In light of the increasing development of chat-based helplines, there is a need for further research on frequent chatters to develop tailored counseling strategies for their needs and to analyze options for an optimized service provision. Study registration DRKS00026671.
Collapse
Affiliation(s)
- Zeki Efe
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Sabrina Baldofski
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | | | - Lukas Guenthner
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | | | | | - Richard Wundrack
- krisenchat gGmbH, Berlin, Germany
- Department of Psychology, Chair of Personality Psychology, Humboldt Universität zu Berlin, Germany
| | - Elisabeth Kohls
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, University Leipzig Medical Center, Leipzig University, Leipzig, Germany
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, University Leipzig Medical Center, Leipzig University, Leipzig, Germany
| |
Collapse
|
14
|
Purtle J, Chance Ortego J, Bandara S, Goldstein A, Pantalone J, Goldman ML. Implementation of the 988 Suicide & Crisis Lifeline: Estimating State-Level Increases in Call Demand Costs and Financing. THE JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS 2023; 26:85-95. [PMID: 37357873 PMCID: PMC10758993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/06/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Per federal law, "988" became the new three-digit dialing code for the National Suicide & Crisis Lifeline on July 16, 2022 (previously reached by dialing "1-800-283-TALK"). AIMS OF THE STUDY This study aimed to produce state-level estimates of: (i) annual increases in 988 Lifeline call volume following 988 implementation, (ii) the cost of these increases, and (iii) the extent to which state and federal funding earmarked for increases in 988 Lifeline call volume are sufficient to meet call demand. METHOD A 50 state pre-post policy implementation design was used. State-level Lifeline call volume data were obtained. For each state, we calculated the absolute difference in number of Lifeline calls in the four-month periods between August-November 2021 (pre-988 implementation) and August-November 2022 (post-988 implementation), and also expressed this difference as percent change and rate per 100,000 population. The difference call volume was multiplied by a published estimate of the cost of a single 988 Lifeline call (USD 82), and then by multiplied by three to produce annual, 12-month state-level cost increase estimates. These figures were then divided by each state's population size to generate cost estimates per state resident. State-level information on the amount of state (FY 2023) and federal SAMHSA (FY 2022) funding earmarked for 988 Lifeline centers in response to 988 implementation were obtained from legal databases and government websites and expressed as dollars per state resident. State-level differences between per state resident estimates of increased cost and funding were calculated to assess the extent to which state and federal funding earmarked for increases in 988 Lifeline call volume were sufficient to meet call demand. RESULTS 988 Lifeline call volume increased in all states post-988 implementation (within-state mean percent change = +32.8%, SD = +20.5%). The total estimated cost needed annually to accommodate increases in 988 Lifeline call volume nationally was approximately USD 46 million. The within-state mean estimate of additional cost per state resident was +USD 0.16 (SD = +USD 0.11). The additional annual cost per state resident exceeded USD 0.40 in three states, was between USD 0.40- USD 0.30 in three states, and between USD 0.30 - USD 0.20 in seven states. Twenty-two states earmarked FY 2023 appropriations for 988 Lifeline centers in response to 988 (within-state mean per state resident = USD 1.51, SD = USD 1.52) and 49 states received SAMHSA 988 capacity building grants (within-state mean per state resident = USD 0.36, SD = USD 0.39). State funding increases exceeded the estimated cost increases in about half of states. CONCLUSIONS The Lifeline's transition to 988 increased 988 Lifeline call volume in all states, but the magnitude of the increase and associated cost was heterogenous across states. State funding earmarked for increases in 988 Lifeline center costs is sufficient in about half of states. Sustained federal funding, and/or increases in state funding, earmarked for 988 Lifeline centers is likely important to ensuring that 988 Lifeline centers have the capacity to meet call demand in the post-988 implementation environment.
Collapse
Affiliation(s)
- Jonathan Purtle
- New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA,
| | | | | | | | | | | |
Collapse
|
15
|
Pleet MM, White J, Zamaria JA, Yehuda R. Reducing the Harms of Nonclinical Psychedelics Use Through a Peer-Support Telephone Helpline. PSYCHEDELIC MEDICINE (NEW ROCHELLE, N.Y.) 2023; 1:69-73. [PMID: 37360327 PMCID: PMC10286261 DOI: 10.1089/psymed.2022.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Introduction A resurgence of interest in the use of psychedelics for mental health and wellness has stimulated greater experimentation with psychedelics in society. Although clinical psychedelic trials protect research participants by offering a safe setting, thorough preparation, and containment during and after ingestion of psychedelic medicines, many try these substances without the benefit of these safeguards. Materials and Methods We analyzed data gathered from 884 callers to a psychedelic helpline to determine whether a helpline model could reduce the risks associated with nonclinical psychedelics use. Results In total, 65.9% of callers indicated that the helpline de-escalated them from psychological distress. If not for their conversation with the helpline, 29.3% of callers indicated they may have been harmed; 12.5% indicated that they may have called 911; and 10.8% indicated they may have gone to the emergency room. Conclusion The data suggest that access to a psychedelic helpline surrounding psychedelic experiences may avert harmful outcomes and offset the burden on emergency and medical services.
Collapse
Affiliation(s)
- Mollie M. Pleet
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
- Social Neuroscience and Psychotherapy Lab, Department of Mental Health, Portland VA Research Foundation, Portland, Oregon, USA
| | - Joshua White
- Fireside Project, San Francisco, California, USA
| | - Joseph A. Zamaria
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Rachel Yehuda
- James J. Peters Bronx Veterans Affairs Medical Center, Center for Psychedelic Assisted Psychotherapy and Trauma Research, Psychiatry Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
16
|
Broadbent M, Medina Grespan M, Axford K, Zhang X, Srikumar V, Kious B, Imel Z. A machine learning approach to identifying suicide risk among text-based crisis counseling encounters. Front Psychiatry 2023; 14:1110527. [PMID: 37032952 PMCID: PMC10076638 DOI: 10.3389/fpsyt.2023.1110527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/23/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction With the increasing utilization of text-based suicide crisis counseling, new means of identifying at risk clients must be explored. Natural language processing (NLP) holds promise for evaluating the content of crisis counseling; here we use a data-driven approach to evaluate NLP methods in identifying client suicide risk. Methods De-identified crisis counseling data from a regional text-based crisis encounter and mobile tipline application were used to evaluate two modeling approaches in classifying client suicide risk levels. A manual evaluation of model errors and system behavior was conducted. Results The neural model outperformed a term frequency-inverse document frequency (tf-idf) model in the false-negative rate. While 75% of the neural model's false negative encounters had some discussion of suicidality, 62.5% saw a resolution of the client's initial concerns. Similarly, the neural model detected signals of suicidality in 60.6% of false-positive encounters. Discussion The neural model demonstrated greater sensitivity in the detection of client suicide risk. A manual assessment of errors and model performance reflected these same findings, detecting higher levels of risk in many of the false-positive encounters and lower levels of risk in many of the false negatives. NLP-based models can detect the suicide risk of text-based crisis encounters from the encounter's content.
Collapse
Affiliation(s)
- Meghan Broadbent
- Educational Psychology, The University of Utah, Salt Lake City, UT, United States
| | - Mattia Medina Grespan
- Kahlert School of Computing, The University of Utah, Salt Lake City, UT, United States
| | - Katherine Axford
- Educational Psychology, The University of Utah, Salt Lake City, UT, United States
| | - Xinyao Zhang
- Educational Psychology, The University of Utah, Salt Lake City, UT, United States
| | - Vivek Srikumar
- Kahlert School of Computing, The University of Utah, Salt Lake City, UT, United States
| | - Brent Kious
- Department of Psychiatry, The University of Utah, Salt Lake City, UT, United States
| | - Zac Imel
- Educational Psychology, The University of Utah, Salt Lake City, UT, United States
| |
Collapse
|
17
|
Zabelski S, Kaniuka AR, A Robertson R, Cramer RJ. Crisis Lines: Current Status and Recommendations for Research and Policy. Psychiatr Serv 2022; 74:505-512. [PMID: 36475827 DOI: 10.1176/appi.ps.20220294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The 988 telephone number was established by the National Suicide Hotline Designation Act of 2020 and implemented in July 2022 as a more accessible way to reach the National Suicide Prevention Lifeline. Current financial and training resources, however, are insufficient to ensure effective implementation. METHODS To better understand the state of the literature on crisis support lines in light of the 988 transition, the authors summarized research on suicidal and nonsuicidal outcomes of callers, research on other types of crisis support services, and the benefits of text- and chat-based crisis lines. RESULTS Overall, existing evidence for the effectiveness of crisis lines has been weak and has primarily focused on short-term improvements in user distress and on user satisfaction. In addition, research on crisis lines specifically targeted to marginalized populations (e.g., sexual minority groups) and on text- or chat-based crisis lines is lacking. CONCLUSIONS The policy-focused recommendations derived from this review include the need for additional research on crisis lines, design and evaluation of culturally tailored training for volunteers and staff, and ethical oversight of private data collected from crisis services. Scaling up state-level planning and comprehensive crisis systems is necessary to successfully implement 988 and to fill current training and research gaps.
Collapse
Affiliation(s)
- Sasha Zabelski
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte
| | - Andréa R Kaniuka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte
| | - Ryan A Robertson
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte
| | - Robert J Cramer
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte
| |
Collapse
|
18
|
Côté LP, Mishara BL. Effect of helping suicidal people using text messaging: An evaluation of effects and best practices of the Canadian suicide prevention Service's text helpline. Suicide Life Threat Behav 2022; 52:1140-1148. [PMID: 35946317 DOI: 10.1111/sltb.12908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/11/2022] [Accepted: 08/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Empirical research on best practices in suicide prevention text intervention is scarce. We present analyses of exchanges concerning suicide on the Canadian Suicide Prevention Service (CSPS) text helpline. OBJECTIVE To describe the users of the CSPS text service, explore the perceived impact of the service, and identify intervention characteristics associated with a greater likelihood of positive or negative effects of the exchanges. METHODS We analyzed data from 112 transcripts using quantitative content analysis, counselor assessments of the calls, and responses by callers to pre-call questionnaires. RESULTS Counselors infrequently conducted a complete suicide risk assessment, but almost always thoroughly explored resources and discussed possible solutions to callers' problems. An operational action plan was rarely developed. Only one technique, reinforcing a strength or a positive action of the caller, was a significant predictor of positive effects of the call. The number of words exchanged during the intervention was positively correlated with the completeness of explorations of resources and solutions and the development of an action plan. CONCLUSIONS High-quality effective interventions can be delivered via text messages. Using reinforcement of strengths and encouraging longer calls is recommended. Intervention effects were comparable to those reported in studies of telephone and chat services.
Collapse
Affiliation(s)
- Louis-Philippe Côté
- Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices (CRISE), Université du Québec à Montréal, Montréal, Québec, Canada
| | - Brian L Mishara
- Ethical Issues and End of Life Practices (CRISE), Psychology Department, Université du Québec à Montréal, Montréal, Québec, Canada
| |
Collapse
|
19
|
Matthews S, Cantor JH, Brooks Holliday S, Eberhart NK, Breslau J, Bialas A, McBain RK. Mental Health Emergency Hotlines in the United States: A Scoping Review (2012-2021). Psychiatr Serv 2022; 74:513-522. [PMID: 36254453 DOI: 10.1176/appi.ps.20220128] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mental health emergency hotlines provide clinical supports and connection to services. This scoping review describes the current literature on hotlines in the United States, including which populations they do and do not reach, typical call volumes and engagement levels, barriers to and facilitators of implementation, and common call outcomes. The review also identifies gaps in the literature and presents recommendations. METHODS A systematic search of peer-reviewed articles on U.S.-based telephone, text, and chat hotlines published between January 2012 and December 2021 retrieved 1,049 articles. In total, 96 articles met criteria for full-text review, of which 53 met full inclusion criteria. RESULTS Approximately half of the included studies (N=25) focused on descriptive information of callers, most of whom were females, younger adults, and White; veteran hotlines typically reached older men. Common reasons for calling were suicidality, depression, and interpersonal problems. Of studies examining intervention effects (N=20), few assessed hotlines as interventions (N=6), and few evaluated caller behavioral outcomes (N=4), reporting reduced distress and suicidality among callers after hotline engagement. However, these studies also suggested areas for improvement, including reaching underrepresented high-risk populations. Six studies reported implementation needs, such as investments in data collection and evaluation, staff training, and sustainable funding. CONCLUSIONS Hotlines appear to be more effective at reaching some populations than others, indicating that more intensive outreach efforts may be necessary to engage underrepresented high-risk populations. The findings also indicated limited evidence on the relationship between use of hotlines-particularly local text and chat hotlines-and caller outcomes, highlighting an area for further investigation.
Collapse
Affiliation(s)
- Samantha Matthews
- RAND Corporation, Santa Monica, California (Matthews, Cantor, Brooks Holliday, Eberhart), Pittsburgh (Breslau, Bialas), and Washington, D.C. (McBain)
| | - Jonathan H Cantor
- RAND Corporation, Santa Monica, California (Matthews, Cantor, Brooks Holliday, Eberhart), Pittsburgh (Breslau, Bialas), and Washington, D.C. (McBain)
| | - Stephanie Brooks Holliday
- RAND Corporation, Santa Monica, California (Matthews, Cantor, Brooks Holliday, Eberhart), Pittsburgh (Breslau, Bialas), and Washington, D.C. (McBain)
| | - Nicole K Eberhart
- RAND Corporation, Santa Monica, California (Matthews, Cantor, Brooks Holliday, Eberhart), Pittsburgh (Breslau, Bialas), and Washington, D.C. (McBain)
| | - Joshua Breslau
- RAND Corporation, Santa Monica, California (Matthews, Cantor, Brooks Holliday, Eberhart), Pittsburgh (Breslau, Bialas), and Washington, D.C. (McBain)
| | - Armenda Bialas
- RAND Corporation, Santa Monica, California (Matthews, Cantor, Brooks Holliday, Eberhart), Pittsburgh (Breslau, Bialas), and Washington, D.C. (McBain)
| | - Ryan K McBain
- RAND Corporation, Santa Monica, California (Matthews, Cantor, Brooks Holliday, Eberhart), Pittsburgh (Breslau, Bialas), and Washington, D.C. (McBain)
| |
Collapse
|
20
|
Janssen W, van Raak J, van der Lucht Y, van Ballegooijen W, Mérelle S. Can Outcomes of a Chat-Based Suicide Prevention Helpline Be Improved by Training Counselors in Motivational Interviewing? A Non-randomized Controlled Trial. Front Digit Health 2022; 4:871841. [PMID: 35801118 PMCID: PMC9253377 DOI: 10.3389/fdgth.2022.871841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To examine whether the outcomes of a chat-based suicide-prevention helpline could be improved by training counselors in motivational interviewing (MI). Methods In a pre- and post-test design, visitors of a chat-based suicide prevention helpline received either the Five-Phase Model (treatment as usual [TAU]) or MI. They completed a pre- and post-chat questionnaire on several suicide-related risk factors. Linear mixed modeling was used to estimate the effect of the condition. Furthermore, the treatment proficiency of newly trained counselors was assessed using MI-Scope. Results A total of 756 visitors and 55 counselors were included in this study. The visitors showed an improvement in suicidal ideation and psychological risk factors after a chat conversation. However, there were no significant differences between the MI and TAU conditions (β = 0.03, 95% CI [−0.23–0.30], p = 0.80). The treatment integrity indices showed that the counselors mostly used MI-consistent techniques but were unable to strategically employ these techniques to evoke enough change talk. Conclusions MI and TAU led to comparable outcomes in a chat-based suicide prevention helpline. The effectiveness of MI might improve by intensifying or improving the training of counselors, keeping the process of engaging more concise or offering visitors multiple sessions of MI.
Collapse
Affiliation(s)
- Wilco Janssen
- 113 Suicide Prevention, Amsterdam, Netherlands
- *Correspondence: Wilco Janssen
| | | | | | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC, Amsterdam, Netherlands
| | | |
Collapse
|
21
|
Lake AM, Niederkrotenthaler T, Aspden R, Kleinman M, Hoyte‐Badu AM, Galfalvy H, Gould MS. Lifeline Crisis Chat: Coding form development and findings on chatters' risk status and counselor behaviors. Suicide Life Threat Behav 2022; 52:452-466. [PMID: 35112387 PMCID: PMC9304218 DOI: 10.1111/sltb.12835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/12/2021] [Accepted: 11/08/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to develop a reliable tool for the abstraction of data from crisis chat transcripts; to describe chatters' suicide risk status and selected counselor behaviors; and to examine the relationship of chatters' self-reported pre-chat suicidal thoughts to counselor behaviors and to chatters' disclosures of suicide risk during the chat conversation. METHODS Coders used an instrument developed for this study to abstract data from 1034 crisis chats handled by the National Suicide Prevention Lifeline Crisis Chat network in 2015. The relationship of transcript coding data to data from an automated pre-chat survey (PCS) was examined. RESULTS Lifeline Crisis Chat serves a young (median age = 21), high-risk population: 84.0% of chats (869/1034) came from chatters endorsing current or recent suicidal thoughts on the PCS. Counselors engaged in rapport-building on 93.3%, problem-solving on 70.1%, and suicide risk assessment on 67.7% of these 869 chats. Counselor risk assessment behavior, and the availability of information on suicide risk in the chat transcript, varied significantly by the chatter's PCS response. CONCLUSION Crisis counselors are able to implement keystones of Lifeline's crisis intervention model over the medium of online chat. Additional efforts are needed to ensure that suicide risk is assessed on every chat.
Collapse
Affiliation(s)
- Alison M. Lake
- Division of Child and Adolescent PsychiatryNew York State Psychiatric InstituteNew YorkNew YorkUSA
| | - Thomas Niederkrotenthaler
- Department of Social and Preventive MedicineCenter for Public HealthMedical University of ViennaWienAustria
| | - Rebecca Aspden
- Department of Child and Adolescent Psychiatry and Behavioral SciencesChildren’s Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Marjorie Kleinman
- Division of Child and Adolescent PsychiatryNew York State Psychiatric InstituteNew YorkNew YorkUSA
| | - Amanda M. Hoyte‐Badu
- Division of Child and Adolescent PsychiatryNew York State Psychiatric InstituteNew YorkNew YorkUSA
| | - Hanga Galfalvy
- Department of PsychiatryColumbia University College of Physicians & SurgeonsNew YorkNew YorkUSA,Department of BiostatisticsColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
| | - Madelyn S. Gould
- Division of Child and Adolescent PsychiatryNew York State Psychiatric InstituteNew YorkNew YorkUSA,Division of Child and Adolescent PsychiatryColumbia University College of Physicians & SurgeonsNew YorkNew YorkUSA,Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
| |
Collapse
|
22
|
Gould MS, Pisani A, Gallo C, Ertefaie A, Harrington D, Kelberman C, Green S. Crisis text-line interventions: Evaluation of texters' perceptions of effectiveness. Suicide Life Threat Behav 2022; 52:583-595. [PMID: 35599358 PMCID: PMC9322288 DOI: 10.1111/sltb.12873] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Crisis Text Line (CTL), the largest provider of text-based crisis intervention services in the U.S., has answered nearly 7 million conversations since its inception in 2013. The study's objective was to assess texter's perceptions of the effectiveness of CTL crisis interventions. METHOD Survey data completed by 85,877 texters linked to volunteer crisis counselor (CC) reports from October 12, 2017, to October 11, 2018 were analyzed. The relationship of several effectiveness measures with texters' demographic and psychosocial characteristics, frequency of CTL usage, and texters' perceptions of engagement with their CCs was examined using a series of logistic regression analyses. RESULTS By the end of the text-based conversation, nearly 90% of suicidal texters reported that the conversation was helpful, and nearly half reported being less suicidal. CONCLUSIONS Our study offers evidence for CTL's perceived effectiveness. These findings are of critical importance in light of the launch of a nationwide three-digit number (988) for suicide prevention and mental health crisis supports in the U.S., which will include texting.
Collapse
Affiliation(s)
- Madelyn S. Gould
- Department of PsychiatryColumbia UniversityNew YorkNew YorkUSA
- Department of EpidemiologyColumbia UniversityNew YorkNew YorkUSA
| | - Anthony Pisani
- Departments of Psychiatry and PediatricsCenter for the Study and Prevention of SuicideUniversity of Rochester MedicalRochesterNew YorkUSA
| | - Carlos Gallo
- Department of Psychiatry and Behavioral ScienceNorthwestern UniversityChicagoIllinoisUSA
| | - Ashkan Ertefaie
- Department of Biostatistics and Computational BiologyUniversity of RochesterRochesterNew YorkUSA
| | - Donald Harrington
- Department of Biostatistics and Computational BiologyUniversity of RochesterRochesterNew YorkUSA
| | - Caroline Kelberman
- Departments of Psychiatry and PediatricsCenter for the Study and Prevention of SuicideUniversity of Rochester MedicalRochesterNew YorkUSA
| | - Shannon Green
- Data and Research Team, Crisis Text LineNew YorkNew YorkUSA
| |
Collapse
|
23
|
Pisani AR, Gould MS, Gallo C, Ertefaie A, Kelberman C, Harrington D, Weller D, Green S. Individuals who text crisis text line: Key characteristics and opportunities for suicide prevention. Suicide Life Threat Behav 2022; 52:567-582. [PMID: 35615898 PMCID: PMC9324113 DOI: 10.1111/sltb.12872] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Text-based crisis services are increasingly prominent, with inclusion in the national 988 crisis number launching in 2022. Yet little is known about who uses them. This study seeks to understand the population served by Crisis Text Line (CTL), the largest crisis text service in the United States. METHODS Secondary data analysis was conducted on de-identified Crisis Counselor reports, texter post-conversation survey responses, and anonymized text conversation data from 85,877 texters who contacted CTL during a 12-month period. We examined Crisis Counselor's ratings of suicide ideation severity, texters' reports of race, gender, sexual orientation, recent mental health symptoms, and additional sources of help, and logs of frequency of contact. RESULTS 76% of texters were under 25. 79% were female. 48% identified as other than heterosexual/straight. 64% had only one conversation. 79% were above the clinical cutoff for depression and 80% for anxiety, while 23% had thoughts of suicide. 23% received help from a doctor or therapist, and 28% received help only from CTL. CONCLUSIONS CTL reaches a highly distressed, young, mostly female population, including typically underserved minorities and a substantial percentage of individuals who do not receive help elsewhere. These findings support the decision to include texting in the forthcoming national 988 implementation.
Collapse
Affiliation(s)
- Anthony R. Pisani
- Department of Psychiatry, Center for the Study and Prevention of SuicideUniversity of RochesterRochesterNew YorkUSA
| | - Madelyn S. Gould
- Department of PsychiatryColumbia UniversityNew YorkNew YorkUSA,Department of EpidemiologyColumbia UniversityNew YorkNew YorkUSA
| | - Carlos Gallo
- Department of Psychiatry and Behavioral ScienceNorthwestern UniversityChicagoIllinoisUSA
| | - Ashkan Ertefaie
- Department of Biostatics and Computational BiologyUniversity of RochesterRochesterNew YorkUSA
| | - Caroline Kelberman
- Department of Psychiatry, Center for the Study and Prevention of SuicideUniversity of RochesterRochesterNew YorkUSA
| | - Donald Harrington
- Department of Biostatics and Computational BiologyUniversity of RochesterRochesterNew YorkUSA
| | - Daniel Weller
- Department of Biostatics and Computational BiologyUniversity of RochesterRochesterNew YorkUSA
| | | |
Collapse
|
24
|
Stressors and Information-Seeking by Dialysis and Transplant Patients During COVID-19 Reported on a Telephone Hotline: A Mixed Methods Study. Kidney Med 2022; 4:100479. [PMID: 35571230 PMCID: PMC9087151 DOI: 10.1016/j.xkme.2022.100479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Rationale & Objective In early 2020, we activated a telephone hotline, the coronavirus disease 2019 (COVID-19) Kidney or Transplant Listening and Resource Center, to learn more about the impact of the COVID-19 pandemic on the stress and information-seeking behaviors of dialysis and transplant patients. Study Design A mixed-methods study including semi-structured, qualitative interviews probing about emotional, health, and financial challenges experienced and quantitative surveys assessing depression and anxiety levels and information-seeking behaviors. Setting & Participants 99 participants (28 dialysis patients; 71 transplant patients), varying by race and ethnicity (Hispanic, 25.3%; White, 23.2%; Asian, 24.2%; Black, 24.2%), shared their COVID-19 pandemic experiences and information-seeking behaviors by telephone. Interviews and surveys were conducted from June 17, 2020, to November 24, 2020. Analytical Approach Qualitative themes were identified using thematic analysis. Frequencies were calculated to assess levels of depression and anxiety using the Patient Health Questionnaire for Depression and Anxiety and types of information-seeking behaviors. Results 7 themes and 16 subthemes emerged. Themes of commonly reported stressors include postponing medical visits; decreased accessibility of getting medication; difficulty in receiving up-to-date, patient-focused health information and dialysis supplies; and delays in medical appointments. Other stressors include losses of health insurance and income, and increased vigilance in behaviors to avoid contracting COVID-19. 15 participants had moderate to severe anxiety and depression symptoms and reported more frequent and severe panic attacks after the COVID-19 pandemic. Participants sought emotional support from family, friends, and faith communities. They also commonly obtained information from news media and reported needing more transplant-specific updates about COVID-19, and frequent communication from their kidney and transplant specialists. Limitations This convenience sample of individuals willing to share their experiences through a telephone hotline may not generalize to all dialysis and transplant patients; stressors related to the COVID-19 pandemic for these patients continue to change. Conclusions As the impact of the pandemic continues, needs-based interventions tailored for the kidney and transplant community, including access to mental health resources, education, and support for care transitions, should continue.
Collapse
|
25
|
Coady A, Lainchbury K, Godard R, Holtzman S. What twitter can tell us about user experiences of crisis text lines: A qualitative study. Internet Interv 2022; 28:100526. [PMID: 35313611 PMCID: PMC8933810 DOI: 10.1016/j.invent.2022.100526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 03/01/2022] [Accepted: 03/12/2022] [Indexed: 11/19/2022] Open
Abstract
Mental health problems are the leading cause of disability worldwide. Despite the prevalence and cost of mental illness, there are insufficient health services to meet this demand. Crisis hotlines have a number of advantages for addressing mental health challenges and reducing barriers to support. Mental health crisis services have recently expanded beyond telephone hotlines to include other communication modalities such as chat and text messaging services, largely in response to the increased use of mobile phones and text messaging for social communication. Despite the high uptake of crisis text line services (CTLs) and rising mental health problems worldwide, CTLs remain understudied. The current study aimed to address an urgent need to evaluate user experiences with text-based crisis services. This study explored user experiences of CTLs by accessing users' publicly available Twitter posts that describe personal use and experience with CTLs. Data were qualitatively analyzed using thematic analysis. Six main themes were identified from 776 tweets: (1) approval of CTLs, (2) helpful counselling, (3) invalidating or unhelpful counselling, (4) problems with how the service is delivered, (5) features of the service that facilitate accessibility, and (6) indication that the service suits multiple needs. Overall, results provide evidence for the value of text-based crisis support, as many users reported positive experiences of effective counselling that provided helpful coping skills, de-escalation, and reduction of harm. Results also identified areas for improvement, particularly ensuring more timely service delivery and effective communication of empathy. Text-based services may require targeted training to apply methods that effectively convey empathy in this medium. Moving forward, CTL services will require systematic attention in the clinical research literature to ensure their continued success and popularity among users.
Collapse
Affiliation(s)
- Alanna Coady
- Corresponding author at: The University of British Columbia
- Okanagan, ASC 283, 3187 University Way, Kelowna, BC V1V 1V7, Canada.
| | | | | | | |
Collapse
|
26
|
Kohls E, Guenthner L, Baldofski S, Eckert M, Efe Z, Kuehne K, Saee S, Thomas J, Wundrack R, Rummel-Kluge C. Suicidal Ideation Among Children and Young Adults in a 24/7 Messenger-Based Psychological Chat Counseling Service. Front Psychiatry 2022; 13:862298. [PMID: 35418889 PMCID: PMC8995430 DOI: 10.3389/fpsyt.2022.862298] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/07/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Suicidality in children and young adults is a pervasive problem: approximately 40% of respondents in epidemiological surveys in German schools reported suicidal ideation, while up to 9% reported a suicide attempt in the past. While there is compelling evidence for the effectiveness of telephone-based hotline services, an increasing preference of adolescents for messenger-based counseling services can be observed. Therefore, the present study aims to investigate the utilization behavior and user satisfaction of users contacting a German messenger-based chat counseling service ("krisenchat") regarding suicidal ideation. METHODS The present cross-sectional study analyzed retrospective anonymous data on sociodemographic variables, utilization behavior, and user satisfaction of krisenchat users who used the service between May 2020 and July 2021. Chi-square-tests were used to identify associations of sociodemographic characteristics and utilization behavior with suicidal ideation. Mann-Whitney-U-tests were used to compare the user satisfaction and the recommendation-to-others-rate between suicidal and non-suicidal krisenchat-users. RESULTS In total, chat data of N = 11,031 users were collected. Of the n = 6,962 users included in the final analysis, n = 1,444 (20.7%) contacted krisenchat because of suicidal ideation. The average user experiencing suicidal ideation was 17 years old, female and currently not receiving other treatment. Further, suicidal ideation was significantly and positively associated with age and non-suicidal self-injury. Regarding utilization patterns, there were significant positive associations between suicidal ideation and counseling session count, mean amount of messages sent, and mean amount of words used per message by the user. User satisfaction was high, with 64.7% (n = 413) of users that answered the feedback survey and experiencing suicidal ideation rating the help they received as at least "good" and a recommendation rate of 89.6% (n = 571). Most importantly, no differences were found between users reporting suicidal ideation and those that do not regarding satisfaction and the probability of recommending the service. CONCLUSION Results imply satisfaction with the counseling service among users with suicidal ideation. Nevertheless, there is a need for further research into messenger-based counseling services regarding the prevention of suicidal behavior in children, youths, and young adults. Longitudinal studies are especially needed to assess the effectiveness of messenger-based interventions. STUDY REGISTRATION DRKS00026671.
Collapse
Affiliation(s)
- Elisabeth Kohls
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany.,Department of Psychiatry and Psychotherapy, University Leipzig Medical Center, Leipzig University, Leipzig, Germany
| | - Lukas Guenthner
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Sabrina Baldofski
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | | | - Zeki Efe
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Katharina Kuehne
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | | | | | - Richard Wundrack
- krisenchat gGmbH, Berlin, Germany.,Department of Psychology, Chair of Personality Psychology, Humboldt Universität zu Berlin, Berlin, Germany
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany.,Department of Psychiatry and Psychotherapy, University Leipzig Medical Center, Leipzig University, Leipzig, Germany
| |
Collapse
|