Caring Contact Postcards for Loneliness

Not currently recruiting at 2 trial locations

Overseen By Aaron A Call

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Neurocognitive disorder, Cognitive impairment, others

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

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 4

Duration: 12 months

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if friendly postcards from the VA can reduce loneliness and improve mental health in older Veterans. A fellow Veteran mails these postcards, called "Crisis Caring Contacts," and participants receive up to 10 of them. The trial includes two groups: one receives the special postcards, while the other receives regular ones for comparison. The study seeks Veterans aged 50 and older who feel isolated and often miss their VA appointments, despite having health issues. Participants will complete four surveys during the study. As an unphased trial, this study offers Veterans a unique opportunity to contribute to innovative approaches in mental health care.

Will I have to stop taking my current medications?

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

What prior data suggests that these postcards are safe for Veterans?

Research shows that Caring Contacts, messages sent to individuals, can reduce loneliness and improve mental health. Earlier studies found these messages effective in decreasing thoughts of suicide and other mental health issues. Trials demonstrated positive results when Caring Contacts were sent to those who might feel alone or face challenges.

No safety concerns are associated with receiving these messages. Since this trial involves sending postcards, it avoids risks linked to medications or medical procedures. Past studies reported positive responses to these messages, with no negative effects. Participants can generally feel safe and supported when receiving these postcards. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Crisis Caring Contacts postcards because they offer a simple, yet innovative approach to alleviating loneliness. Unlike traditional treatments for loneliness, which might involve therapy sessions or medications, these postcards provide a non-intrusive, personal touch that can make recipients feel valued and remembered. By sending personalized messages, the postcards aim to create a sense of connection and support, potentially helping to reduce feelings of isolation without the need for more intensive interventions. This method is particularly appealing because it can be easily scaled and integrated into existing support systems, offering a cost-effective and accessible option for many individuals.

What evidence suggests that this trial's postcards could be effective for reducing loneliness?

Research has shown that Caring Contacts, simple supportive messages sent to individuals, can reduce loneliness and improve mental health. In this trial, participants in the treatment arm will receive Crisis Caring Contacts postcards. Studies have found that these messages can lower suicidal thoughts, attempts, and even deaths. Specifically, past research indicated that recipients felt more connected and less alone, with a decrease in emotional distress. These findings suggest that receiving Caring Contacts can significantly enhance mental well-being and social connection. ^{1 2 3 4 6}

Who Is on the Research Team?

Alan R. Teo, MD MS

Principal Investigator

VA Portland Health Care System, Portland, OR

Are You a Good Fit for This Trial?

This trial is for Veterans aged 50 or older who feel isolated, have missed VA appointments despite health issues, and have at least two comorbidities. They must not be part of an existing Caring Contacts program or have cognitive impairments that affect decision-making.

Inclusion Criteria

a) Zero completed appointments in the past 6 months and zero appointments scheduled, or b) In the 90th percentile or higher in terms of no-shows or appointments canceled by patient in the prior 12 months

I am 50 years old or older.

Have at least four VA appointments in the prior 6-18 months in primary care or mental health

Exclusion Criteria

I have a condition that affects my ability to make decisions.

No valid mailing address

No valid phone number

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive up to 10 postcards mailed in envelopes from a fellow Veteran (Peer Specialist) from their local VA

12 months

Postcards sent periodically

Follow-up

Participants are monitored for safety and effectiveness after treatment

12 months

4 surveys

What Are the Treatments Tested in This Trial?

Interventions

• Control post cards
• Crisis Caring Contacts post cards

Trial Overview The study tests if 'Caring Contacts' postcards can reduce loneliness in Veterans. Participants will receive up to 10 messages from a Peer Specialist and complete four surveys to help determine the effectiveness of this intervention.

How Is the Trial Designed?

Group I: Treatment Experimental Treatment 1 Intervention

Participants in the treatment arm will receive the intervention post cards

Group II: Control Placebo Group 1 Intervention

Participants in the control arm will receive the control post cards

Crisis Caring Contacts post cards is already approved in United States for the following indications:

Approved in United States as Caring Contacts for:

• Reducing loneliness
• Improving mental health

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Published Research Related to This Trial

A study involving 154 veteran psychiatric inpatients found that 85% preferred to receive Caring Contacts from mental health counselors or primary care physicians, indicating strong support for this intervention among high-risk individuals.

Participants rated Caring Contacts as helpful, with 84% believing it could assist suicidal individuals, and preferred receiving these contacts monthly via postal mail for up to a year.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Veteran Preferences for the Caring Contacts Suicide Prevention Intervention. Reger, MA., Gebhardt, HM., Lee, JM., et al.[2022]

In a randomized controlled trial involving 761 participants, the use of crisis postcards did not show a significant effect on preventing suicide reattempts in the intention-to-treat analysis, suggesting that the intervention may not be effective overall.

However, the per-protocol analysis indicated a strong benefit of the crisis postcard intervention, showing a 61% reduction in the risk of reattempts, highlighting the need for further research to optimize the intervention and improve follow-up rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Employing crisis postcards with case management in Kaohsiung, Taiwan: 6-month outcomes of a randomised controlled trial for suicide attempters. Chen, WJ., Ho, CK., Shyu, SS., et al.[2022]

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 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 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]

The Caring Cards (CC) intervention, which involves Veterans creating supportive cards for peers at risk of suicide, is being evaluated for its feasibility and acceptability among Veterans with a history of suicide risk, with 30 card makers and 50 card recipients participating in the study.

This innovative approach aims to enhance social connectedness and reduce suicidal ideation by fostering a sense of community and support, with the potential for a larger efficacy trial if initial results are positive.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A peer approach to suicide prevention and recovery: Study protocol for a feasibility and acceptability trial of Caring Cards for veterans. Ehret, BC., Chalker, SA., Pozun, CT., et al.[2022]

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]

Citations

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

Comparative effectiveness of two versions of a caring ... Caring Contacts can effectively reduce suicide ideation, attempts, and death. In published clinical trials, Caring Contacts were sent by someone who knew ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT05484297

Increasing Social Connection Through Crisis Caring ... The main purpose is to learn if sending messages from the VA (called "Caring Contacts") reduces loneliness and improves mental health.

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0165032723003658

Comparative effectiveness of two versions of a caring ... Secondary outcomes include C-SSRS at 12 months, and loneliness, return to crisis care for suicidality, and utilization of outpatient mental health services ...

4. researchprotocols.org researchprotocols.org/2025/1/e72140

Exploring the Impact of the Caring Contacts Intervention on ... If effective, our findings will demonstrate that Caring Contacts is beneficial for reducing multiple forms of psychological distress and suicide ...

5. psychiatryonline.org psychiatryonline.org/doi/10.1176/appi.ps.20220632

Qualitative Evaluation of a Caring Letters Suicide ... Caring letters (a.k.a. caring contacts) is an evidence-based intervention for postacute care that involves sending brief, nondemanding messages ...

6. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/10.1111/sltb.13108

Implementation of caring contacts using patient feedback to ... Caring Contacts are a simple intervention that support patient outcomes post-psychiatric discharge. Enhancements to the CC intervention ...