Caring Contacts for Suicide Prevention

(CARE Trial)

Not currently recruiting at 2 trial locations

Overseen By Katherine Anne Comtois, PhD, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Washington State University

Disqualifiers: Cognitive impairment, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

The trial aims to prevent suicide among American Indians and Alaska Natives by testing a simple, caring message system called Caring Contacts. It will explore whether supportive messages can reduce suicidal thoughts and behaviors. Participants will receive either their usual care or usual care plus these caring messages. This trial is for individuals who have thought about or attempted suicide in the past year, identify as American Indian or Alaska Native, and are open to receiving messages through text, email, or mail.

As an unphased trial, this study offers a unique opportunity to contribute to innovative research that could provide crucial support to the community.

Do I need to stop my current medications to join the trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that the Caring Contacts intervention is safe for suicide prevention?

Research has shown that Caring Contacts, a method of sending supportive messages to individuals at risk of suicide, is safe. Over the years, no serious negative effects have been reported from this approach. Studies have found that these messages can reduce the risk of suicide in those who have recently experienced suicidal thoughts or attempts. Various groups, including military members and veterans, have well-received and accepted the method. This suggests that Caring Contacts is a low-risk and effective way to prevent suicide. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Caring Contacts Messages for suicide prevention because they offer a unique approach compared to traditional methods like therapy and medication. Unlike these standard treatments, which often involve direct interaction with mental health professionals, Caring Contacts Messages provide ongoing support through simple, personalized messages. This method is accessible and non-intrusive, aiming to foster a sense of connection and care, which can be crucial for individuals experiencing suicidal ideation. The simplicity and scalability of this approach make it a promising complement to existing mental health strategies.

What evidence suggests that Caring Contacts messages are effective for suicide prevention?

Research has shown that Caring Contacts is a promising method to reduce suicidal thoughts and actions. In this trial, one group of participants will receive Usual Care plus Caring Contacts messages. One study found that Caring Contacts lowered the chances of suicide attempts among U.S. Marines and Army Soldiers. Another analysis found it helps protect against suicide attempts. Additionally, a separate study discovered that Caring Contacts reduced the likelihood of suicidal thoughts and attempts in military personnel. These findings suggest that Caring Contacts can effectively support individuals at risk of suicide. ^{4 6 7 8 9}

Who Is on the Research Team?

Lonnie A Nelson, PhD

Principal Investigator

Washington State University

Are You a Good Fit for This Trial?

This trial is for American Indian or Alaska Native adults who are at least 18 years old, can speak and read English, have had suicidal thoughts or an attempt within the past year, and are willing to receive messages by text, email, or mail. It's not for those unable to consent independently.

Inclusion Criteria

Self-identify as American Indian or Alaska Native

Speak and read English

I am okay with being contacted through text, email, or mail.

Exclusion Criteria

I am unable to understand or sign the consent form by myself.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive Caring Contacts messages via text, email, and postal mail to promote connectedness and prevent suicide

12 months

Ongoing contact through messages

Follow-up

Participants are monitored for suicidal ideation, attempts, and hospitalizations

18 months

What Are the Treatments Tested in This Trial?

Interventions

• Caring Contacts Messages

Trial Overview

The study tests 'Caring Contacts', a suicide prevention approach that involves sending supportive messages to individuals at risk. The effectiveness of this low-cost intervention will be evaluated across four tribal communities.

How Is the Trial Designed?

Group I: Usual Care + Caring Contacts messages Experimental Treatment 2 Interventions

Usual care services plus caring contacts messages

Group II: Usual Care Active Control 1 Intervention

Usual care services provided in that community following identification of suicidal ideation or behavior.

Who Is Running the Clinical Trial?

Washington State University

Lead Sponsor

Trials

114

Recruited

58,800+

University of Washington

Collaborator

Trials

1,858

Recruited

2,023,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Published Research Related to This Trial

Caring Contacts, which are supportive text messages sent to military personnel at risk of suicide, showed a significant reduction in the odds of experiencing suicidal ideation and attempts compared to standard care, suggesting they may be a valuable addition to mental health interventions.

While the primary outcomes did not show significant effects, the secondary outcomes indicated that participants receiving Caring Contacts had lower rates of suicidal ideation and attempts, highlighting the potential of this low-cost intervention in preventing suicidality among military service members.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Augmenting Standard Care for Military Personnel With Brief Caring Text Messages for Suicide Prevention: A Randomized Clinical Trial. Comtois, KA., Kerbrat, AH., DeCou, CR., et al.[2022]

In a pilot study involving 100 recently discharged psychiatric patients, Caring Contacts showed a potential benefit in reducing the worsening of mental health symptoms and suicidal ideation shortly after discharge, particularly on day 4 post-discharge.

Although there were no significant differences between the Caring Contacts and control groups overall, the results suggest that Caring Contacts may help mitigate distress in the immediate post-discharge period, indicating the need for further research with larger sample sizes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Caring Contacts to Reduce Psychiatric Morbidity Following Hospitalization During the COVID-19 Pandemic: A Pilot Randomized Controlled Trial. Holman, S., Steinberg, R., Sinyor, M., et al.[2023]

A quality improvement project at a large VA health care system successfully enrolled 29% of hospitalized veterans at risk for suicide in caring contacts interventions, highlighting the potential for this approach to support veterans post-hospitalization.

Despite high acceptability of the intervention among veterans, barriers such as staff availability and veteran homelessness limited enrollment, indicating a need for strategies to enhance participation in future implementations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Lessons Learned From Implementing a Caring Contacts Clinical Practice Guideline Recommendation. Liu, L., Porter, SA., Gebhardt, H., et al.[2023]

The Caring Contacts suicide prevention intervention is effective and cost-efficient, but patient characteristics have minimal impact on preferences for the intervention's format and delivery, based on a study of 154 veterans.

Older veterans showed a preference for receiving messages as physical letters, while younger veterans preferred handwritten notes with colorful envelopes, suggesting that minor adaptations may enhance engagement for different age groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Differential Preferences for the Caring Contacts Suicide Prevention Intervention Based on Patient Characteristics. Ammerman, BA., Gebhardt, HM., Lee, JM., et al.[2022]

A qualitative study involving experienced suicide researchers revealed significant challenges in defining and reporting adverse events (AEs) and serious adverse events (SAEs) in suicide prevention trials, which complicates safety evaluations.

Participants emphasized the urgent need for clear and consistent definitions and reporting standards for AEs and SAEs to improve the comparability of studies and enhance safety monitoring in at-risk populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Variability in the definition and reporting of adverse events in suicide prevention trials: an examination of the issues and a proposed solution. Oquendo, MA., Feldman, S., Silverman, E., et al.[2022]

A study involving 666 participants (331 patients and 335 healthcare providers) found that adding an introductory phone call to Caring Contacts did not significantly reduce loneliness compared to sending messages without the call.

The results suggest that Caring Contacts can be effectively implemented without the added complexity of introductory calls, maintaining their potential to support individuals with adverse mental health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparative effectiveness of two versions of a caring contacts intervention in healthcare providers, staff, and patients for reducing loneliness and mental distress: A randomized controlled trial. Radin, AK., Shaw, J., Brown, SP., et al.[2023]

The study analyzed 90 caring messages written by 15 peer veterans, revealing three key themes: Shared Military Service, Care, and Overcoming Adversity, which reflect the unique experiences and support among veterans.

These peer-generated messages may enhance feelings of belonging and social support for veterans after psychiatric treatment, potentially improving the effectiveness of existing suicide prevention interventions like Caring Letters.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peer-Written Caring Letters for Veterans after a Suicidal Crisis. Ton, AT., Carter, SP., Leitner, R., et al.[2023]

The study aims to adapt the Caring Contacts suicide prevention approach for use in a VA emergency department, targeting veterans during a critical transition period after discharge.

A pilot program will be conducted to gather qualitative data from staff and stakeholders, which will help create an implementation toolkit for spreading this effective intervention to other VA facilities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adapting and implementing Caring Contacts in a Department of Veterans Affairs emergency department: a pilot study protocol. Landes, SJ., Kirchner, JE., Areno, JP., et al.[2022]

A pilot study of a text-messaging intervention for youths discharged from the hospital after suicidal thoughts showed it was feasible and well-received, helping to reduce suicidal thoughts and behaviors.

The positive results of this intervention led to the Maryland Department of Health expanding the program to offer similar support to all Maryland residents, highlighting its potential effectiveness in suicide prevention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Brief Text-Messaging Intervention for Suicidal Youths After Emergency Department Discharge. Ryan, TC., Chambers, S., Gravey, M., et al.[2022]

A two-hour suicide care educational intervention significantly improved family caregivers' ability to care for suicidal individuals and fostered more positive attitudes towards them, based on a study of 74 participants.

While the intervention did not reduce caregivers' stress levels, it highlighted the importance of providing education to family members, which is often overlooked in suicide prevention programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Short-term effects of a suicide education intervention for family caregivers of people who are suicidal. Sun, FK., Chiang, CY., Lin, YH., et al.[2013]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC10304492/

Comparative effectiveness of two versions of a caring ...

Caring Contacts is one of the only brief interventions with demonstrated effectiveness in reducing suicidal ideation, attempts, and death in randomized clinical ...

2.

sciencedirect.com

sciencedirect.com/science/article/pii/S2688115224014760

Retrospective evaluation of implementation of caring ...

This study demonstrates that Caring Contacts are feasible to deliver to children and adolescents with suicidal thoughts or behaviors, with high fidelity and low ...

3.

researchprotocols.org

researchprotocols.org/2025/1/e72140

Exploring the Impact of the Caring Contacts Intervention on ...

A meta-analysis of Caring Contacts concluded that it has a protective effect against suicide attempts [22]. However, findings on the ...

4.

msrc.fsu.edu

msrc.fsu.edu/funded-research/reviewing-effects-caring-contacts-recon-long-term-follow-study-military-continuity-project/

Reviewing the Effects of Caring Contacts (RECON)

Comtois found that adding a Caring Contacts intervention to the usual treatment reduced the likelihood of U.S. Marines and Army Soldiers experiencing suicidal ...

5.

jamanetwork.com

jamanetwork.com/journals/jamapsychiatry/fullarticle/2723658

Effect of Augmenting Standard Care for Military Personnel ...

However, Caring Contacts reduced the odds of having any suicidal ideation (80% vs 88%) and making a suicide attempt (9% vs 15%). Meaning ...

6.

suny.edu

suny.edu/mental-health/resources/

Find Mental Health Resources Near You

Services Offered. Individual counseling; Group counseling; Wellness programming; Consultation; Crisis intervention; Educational programs (classes, dorms) ...

7.

msrc.fsu.edu

msrc.fsu.edu/blog/caring-contacts-simple-scalable-intervention-reduce-suicidal-ideation-and-attempts/

Caring Contacts: A simple, scalable intervention to reduce ...

In the 1970s, a psychiatrist named Jerome Motto demonstrated that non-demanding caring letters could prevent suicide among high-risk individuals.

8.

nationwidechildrens.org

nationwidechildrens.org/research/areas-of-research/institute-for-mental-and-behavioral-health-research/suicide-prevention-and-research/prevention/services/caring-contacts

Caring Contacts

As part of Nationwide Children's Hospital's commitment to a Zero Suicide mission, the CSPR created a program that sends a series of 19 caring.

9.

mirecc.va.gov

mirecc.va.gov/visn19/cpg/recs/16/

16: Caring Communications - MIRECC / CoE

Caring Communications is a suicide prevention approach that involves sending brief, non-demanding expressions of care and concern at specified intervals over a ...