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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if caring text messages can reduce suicidal thoughts and behaviors among American Indian and Alaska Native youth. Participants will be divided into two groups: one receiving regular care and the other receiving regular care plus supportive texts designed to enhance social connection and resilience. Individuals who identify as American Indian or Alaska Native, have been identified as at risk for suicidality, and have a text-enabled phone might be suitable for this study. As an unphased trial, this study provides a unique opportunity to contribute to innovative mental health support strategies.

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 the caring text message program is safe for AI/AN youth?

Research shows that caring text messages are generally well-received by participants. In past studies, these messages were part of a year-long program to help prevent suicide. Participants reported no major safety issues, suggesting that receiving caring text messages is a safe way to support mental health.

However, everyone's experience can differ. While earlier studies found no major problems, participants should share any concerns with the research team during the trial. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the SBIRT+12 approach for suicide prevention because it adds an innovative layer of support to the standard SBIRT model. Unlike traditional methods, which typically involve brief interventions and referrals, SBIRT+12 includes a unique, year-long follow-up period where participants receive caring text messages tailored from proven suicide prevention strategies. This continuous, personalized communication aims to provide ongoing emotional support and reduce suicide risk, particularly among American Indian and Alaska Native young adults. This method stands out as it incorporates modern technology to maintain engagement and potentially enhance the effectiveness of existing interventions.

What evidence suggests that caring text messages are effective for suicide prevention among AI/AN youth?

Research has shown that caring text messages can help reduce suicidal thoughts and attempts. These messages aim to make American-Indian and Alaska Native youth feel more connected and supported. Studies have found that regular, supportive communication can boost resilience and social involvement in at-risk young people. In this trial, one group will receive the SBIRT model with usual care, while another group will receive the SBIRT model enhanced by caring text messages over a year. This method, adapted from successful programs in similar communities, shows promise in managing suicide risk. ^{2 3 6 7 8}

Who Is on the Research Team?

Spero Manson, PhD

Principal Investigator

University of Colorado, Denver

Dedra Buchwald, MD

Principal Investigator

University of Washington

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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 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]

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]

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 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 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]

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 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]

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]

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]

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]

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]

Citations

1. sciencedirect.com sciencedirect.com/org/science/article/pii/S1929074825006493

Caring Text Messages for Suicide Prevention in Urban ... Our double-blinded, 2-armed randomized controlled trial is designed to test the effectiveness of a 12-month intervention that combined caring text messages ...

2. withpower.com withpower.com/trial/phase-suicide-2-2020-8c38a

Caring Text Messages for Suicide Prevention This study compares the effectiveness of a program to detect and manage suicide risk among American-Indian and Alaska Native (AI/AN) youth.

3. coloradosph.cuanschutz.edu coloradosph.cuanschutz.edu/research-and-practice/centers-programs/caianh/projects/past-work/suicide-prevention-hub

Suicide Prevention Hub for Urban AI/AN Youth and Young ... ... SBIRT with either 6 months (SBIRT+6) or 12 months (SBIRT+12) of text messages. Primary outcomes will be self-reported suicidal ideation, attempts, and ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9850124/

Using SBIRT (Screen, Brief Intervention, and Referral ... Demonstrated effectiveness of SBIRT for patients, students, and practitioners. Research has shown that for effective screening and treatment, screening ...

5. samhsa.gov samhsa.gov/substance-use/treatment/sbirt

Screening, Brief Intervention, and Referral to Treatment ... SBIRT is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use ...

6. researchprotocols.org researchprotocols.org/2025/1/e71344

Caring Text Messages for Suicide Prevention in Urban ... Our double-blinded, 2-armed randomized controlled trial is designed to test the effectiveness of a 12-month intervention that combined caring ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12301528/

Expanding our understanding of digital mental health ... ... messages (SBIRT +12) for a 12-month period following identification of suicide risk. Quantitative outcome measures will be collected at baseline, 6, and 12 ...

8. researchgate.net researchgate.net/publication/395891567_Caring_Text_Messages_for_Suicide_Prevention_in_Urban_American_Indian_Youth_Protocol_for_a_Randomized_Controlled_Trial

Caring Text Messages for Suicide Prevention in Urban ... OBJECTIVE We conducted a randomized controlled trial to determine if one-way text messages improved attendance to a 14-months follow-up cervical cancer ...