Caring Text Messages for Suicide Prevention

(SUNDANCE Trial)

Recruiting at 1 trial location

Overseen By Erin Poole, MS

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: University of Colorado, Denver

Disqualifiers: Under 18, Imminent self-harm, Hospitalized

Compensation: Varies

Number of Visits: 12

698 Participants Needed

Trial Summary

What is the purpose of this trial?

This study compares the effectiveness of a program to detect and manage suicide risk among American-Indian and Alaska Native (AI/AN) youth. Half of the participants will receive caring text messages to reduce suicidal thoughts, attempts, and hospitalizations and to increase engagement, social connectedness, and resilience in at-risk youth. The other half will receive usual care that does not include the caring text messages.

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 data supports the effectiveness of the treatment SBIRT+12, SBIRT with 12 months of caring text messages, SBIRT+12, SBIRT+Usual Care, SBIRT+Usual Care, Screening, Brief Intervention, and Referral to Treatment with usual care?

SBIRT (Screening, Brief Intervention, and Referral to Treatment) is effective in reducing risky alcohol use and improving follow-up care when combined with motivational interviewing, which suggests that similar supportive approaches like caring text messages could enhance its effectiveness in suicide prevention. ^{1 2 3 4 5}

Is SBIRT with caring text messages safe for humans?

The research articles do not provide specific safety data for SBIRT with caring text messages, but SBIRT itself is generally considered a safe and effective process for addressing risky substance use. ^{1 3 5 6 7}

How is the SBIRT+12 treatment for suicide prevention different from other treatments?

The SBIRT+12 treatment is unique because it combines the Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach with 12 months of caring text messages, providing ongoing support and connection, which is not typically part of standard care. This method leverages the accessibility and cost-effectiveness of text messages to maintain contact and express care, aiming to reduce suicide risk. ^{8 9 10 11 12}

Research Team

Spero Manson, PhD

Principal Investigator

University of Colorado, Denver

Dedra Buchwald, MD

Principal Investigator

University of Washington

Eligibility Criteria

This trial is for American Indian or Alaska Native youth who can read and speak English, have a text-enabled mobile phone, and are at mild to severe risk of suicidality but not in immediate danger of self-harm. They must be able to consent and participate voluntarily.

Inclusion Criteria

I am willing and able to join the study voluntarily.

Have a text-enabled mobile phone

I am mentally capable of understanding and signing a consent form on my own.

Exclusion Criteria

I am under 18 years old.

I am currently in the hospital.

In danger of imminent self-harm

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

SBIRT Intervention

Participants receive the SBIRT model intervention, with the experimental group receiving additional caring text messages for 12 months

12 months

Baseline, 6 months, 12 months

Follow-up

Participants are monitored for changes in hospitalizations, suicidal ideation, suicide attempts, and social connectedness

12 months

Baseline, 6 months, 12 months

Treatment Details

Interventions

• SBIRT+12
• SBIRT+Usual Care

Trial Overview The study is testing the effectiveness of caring text messages (SBIRT+12) versus usual care without these messages (SBIRT+Usual Care) in reducing suicidal thoughts, attempts, hospitalizations while increasing engagement, social connectedness, and resilience among AI/AN youth.

Participant Groups

Group I: SBIRT+12 Experimental Treatment 1 Intervention

The standard SBIRT model is augmented by a 12 month period following identification of suicide risk during which participants will receive caring text messages adapted from empirically-based, effective interventions for suicide prevention among American Indian and Alaska Native young adults.

Group II: SBIRT+Usual Care Placebo Group 1 Intervention

The control arm of the trial will receive the usual care prescribed in the Screening, Brief Intervention and Referral to Treatment (SBIRT) model.

SBIRT+12 is already approved in United States for the following indications:

Approved in United States as SBIRT+12 for:

• Suicide prevention in American Indian and Alaska Native youth

Who Is Running the Clinical Trial?

University of Colorado, Denver

Lead Sponsor

Trials

1,842

Recruited

3,028,000+

University of New Mexico

Collaborator

Trials

393

Recruited

3,526,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Washington State University

Collaborator

Trials

114

Recruited

58,800+

Findings from Research

This study will test a nurse-led toolkit designed to enhance the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in 14 acute care hospitals, aiming to improve the recognition and treatment of risky substance use among patients.

The effectiveness of the SBIRT toolkit will be evaluated by analyzing documentation of its delivery in electronic medical records over 12 months, with the goal of improving clinician engagement in addressing substance use issues and ultimately reducing substance use disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Study protocol testing toolkit versus usual care for implementation of screening, brief intervention, referral to treatment in hospitals: a phased cluster randomized approach. Newhouse, R., Janney, M., Gilbert, A., et al.[2020]

The study analyzed prescreening outcomes from 14,447 patient visits in both inpatient and outpatient settings, finding that both the medical setting and the method of prescreening (self-administered vs interview) significantly influenced the results.

Among patients who prescreened positive for alcohol, the setting also affected their mean screening scores, indicating that the effectiveness of SBIRT may vary based on the context and method of administration.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Assessment of SBIRT Prescreening and Screening Outcomes by Medical Setting and Administration Methodology. Agley, J., Crabb, DW., Harris, LE., et al.[2020]

Training baccalaureate student nurses in SBIRT significantly improved their attitudes towards patients who use alcohol, indicating that education can enhance the delivery of care for substance use issues.

While the training had a positive impact on attitudes towards alcohol use, changes in attitudes regarding patients who use drugs were less pronounced, suggesting a need for further education in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Screening, Brief Intervention, and Referral to Treatment (SBIRT) education and training on nursing students' attitudes toward working with patients who use alcohol and drugs. Puskar, K., Gotham, HJ., Terhorst, L., et al.[2015]

The SBIRT program implemented in a trauma division has maintained a high screening rate of over 92% for at-risk alcohol use among inpatient admissions since 2009.

Patients who received motivational interviewing from wellness specialists had a significantly higher follow-up rate of 52% compared to only 21% for those referred to exercise physiology, indicating that motivational interviewing is more effective in engaging at-risk alcohol users in follow-up care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Increasing Follow-up Outcomes of At-Risk Alcohol Patients Using Motivational Interviewing. Wagner, AJ., Garbers, R., Lang, A., et al.[2019]

A study involving 80 medical residents showed that both a longer 4- to 6-hour SBIRT/MI training and a shorter 1-hour session were feasible and well-received, with high satisfaction reported overall.

However, residents from emergency medicine (EM) reported lower satisfaction with the shorter training, suggesting that training length and format may impact the effectiveness of SBIRT/MI training in different medical specialties.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Screening, Brief Intervention, Referral to Treatment (SBIRT), and Motivational Interviewing for PGY-1 Medical Residents. Agley, J., Gassman, RA., DeSalle, M., et al.[2018]

The implementation of SBIRT (Screening, Brief Intervention, and Referral to Treatment) at Vancouver General Hospital for trauma patients showed that 68% of surveyed patients had lower alcohol use scores after intervention, indicating potential effectiveness in reducing risky alcohol use.

However, many patients did not recall being screened or receiving the brief intervention, suggesting a need for improved timing and follow-up systems to enhance the impact of SBIRT in trauma care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

SBIRT (Screening, Brief Intervention, and Referral to Treatment) Among Trauma Patients: A Review of the Inpatient Process and Patient Experience. Gormican, EK., Hussein, ZS.[2017]

The study identified seven distinct SBIRT processes for substance use and five for tobacco use across 14 acute care facilities, highlighting variability in implementation despite a consistent overall function.

To effectively disseminate SBIRT in acute care settings, it is crucial to understand and tailor the implementation strategies to the specific local contexts and clinician involvement at each facility.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Variation in SBIRT delivery among acute care facilities. Keen, A., Thoele, K., Newhouse, R.[2020]

The Caring Cards intervention, which involves Veterans creating supportive cards for peers recently discharged from psychiatric hospitalization, demonstrated high feasibility with an 81% attendance rate in the card-making group.

The program was well-received, with 69% of eligible card recipients reached for follow-up and 50% providing positive feedback, indicating its potential as a supportive tool in suicide prevention for Veterans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Designed and created for a veteran by a veteran: A pilot study of caring cards for suicide prevention. Ehret, BC., Treichler, EBH., Ehret, PJ., et al.[2022]

In a study involving 10,666 patients who attempted suicide, over 8,335 (about 78%) were lost to follow-up after 6 months, highlighting a significant challenge in maintaining contact for ongoing support.

Factors associated with loss to follow-up included being a non-first suicide attempter, alcohol use, and lacking a companion during the emergency room visit, while longer hospital stays appeared to help retain patients in the follow-up program.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Loss to follow-up in a population-wide brief contact intervention to prevent suicide attempts - The VigilanS program, France. Fossi, LD., Debien, C., Demarty, AL., 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]

The RAFT (Reconnecting AFTer a suicide attempt) intervention combines SMS contacts with web-based therapeutic content, addressing key risk factors and providing ongoing support to individuals after a suicide attempt, which could help reduce repeat attempts.

The design of the intervention was informed by individuals with lived experience and clinical experts, ensuring it meets the specific needs of this population, and a pilot study is currently testing its feasibility and acceptability.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Mobile Text Message Intervention to Reduce Repeat Suicidal Episodes: Design and Development of Reconnecting After a Suicide Attempt (RAFT). Larsen, ME., Shand, F., Morley, K., et al.[2020]

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]

References

1. England pubmed.ncbi.nlm.nih.gov

Study protocol testing toolkit versus usual care for implementation of screening, brief intervention, referral to treatment in hospitals: a phased cluster randomized approach. [2020]

2. United States pubmed.ncbi.nlm.nih.gov

An Assessment of SBIRT Prescreening and Screening Outcomes by Medical Setting and Administration Methodology. [2020]

3. United States pubmed.ncbi.nlm.nih.gov

Effects of Screening, Brief Intervention, and Referral to Treatment (SBIRT) education and training on nursing students' attitudes toward working with patients who use alcohol and drugs. [2015]

4. United States pubmed.ncbi.nlm.nih.gov

Increasing Follow-up Outcomes of At-Risk Alcohol Patients Using Motivational Interviewing. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Screening, Brief Intervention, Referral to Treatment (SBIRT), and Motivational Interviewing for PGY-1 Medical Residents. [2018]

6. United States pubmed.ncbi.nlm.nih.gov

SBIRT (Screening, Brief Intervention, and Referral to Treatment) Among Trauma Patients: A Review of the Inpatient Process and Patient Experience. [2017]

7. United States pubmed.ncbi.nlm.nih.gov

Variation in SBIRT delivery among acute care facilities. [2020]

8. England pubmed.ncbi.nlm.nih.gov

Designed and created for a veteran by a veteran: A pilot study of caring cards for suicide prevention. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Loss to follow-up in a population-wide brief contact intervention to prevent suicide attempts - The VigilanS program, France. [2022]

10. United States 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. [2022]

11. Canada pubmed.ncbi.nlm.nih.gov

A Mobile Text Message Intervention to Reduce Repeat Suicidal Episodes: Design and Development of Reconnecting After a Suicide Attempt (RAFT). [2020]

12. England pubmed.ncbi.nlm.nih.gov

Peer-Written Caring Letters for Veterans after a Suicidal Crisis. [2023]