Text-based Support for Suicide Prevention

(TESP Trial)

Recruiting at 1 trial location

Overseen By Ewa Czyz, Ph.D.

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University of Michigan

Disqualifiers: Medically unstable, Severe cognitive impairment, others

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

Compensation: Varies

Number of Visits: Unknown

Duration: 6 weeks

420 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if a text-based intervention can assist parents of teens at risk of suicide. It examines whether these messages can impact the period following a teen's emergency room visit for suicidal thoughts or attempts. Participants include parents and their teens, aged 13-17, who have recently experienced serious suicidal thoughts or attempts within the last month. Parents must own a cell phone to receive the text messages. As an unphased trial, this study offers families a unique opportunity to contribute to innovative research that could provide vital support to others in similar situations.

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 this text-based intervention is safe for adolescents?

Research has shown that using text messages to support teenagers at risk of suicide is both feasible and welcomed. In one study with 40 teenagers, a text-based support system received positive feedback and could be enhanced with their input, indicating it as a comfortable and friendly way to offer help.

Other studies have examined safety plans that include text messaging, finding them effective and accepted by young people dealing with suicidal thoughts or actions. However, while these methods are well-received, they do not always reduce harmful thoughts and actions during a crisis.

In summary, text-based help has proven to be safe and well-accepted, making it a promising way to support young people in need. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the text-based support for suicide prevention because it offers a novel way to provide ongoing care outside of the hospital setting. Unlike traditional methods that rely on face-to-face therapy or medication, this intervention uses daily text messaging to engage both adolescents and their parents, creating a continuous support system. The parent-centered messaging includes a unique element where messages are sent based on a randomized schedule, allowing for real-time adaptability and personalized support. This approach could significantly enhance communication and follow-up care, potentially reducing the risk of suicide more effectively than existing methods.

What evidence suggests that this text-based intervention is effective for suicide prevention?

Research has shown that text messaging can be a useful tool for supporting teenagers' mental health. One study found that text messages can effectively expand suicide prevention programs, especially in schools. Another study showed that teens who received support through text messages were less likely to need another psychiatric visit within six months. Text therapy is also easy to use and widely accessible, making it a promising option for supporting young people's mental health. In this trial, one arm will provide standard emergency department (ED) care with a text-based intervention, which includes adolescent-centered and parent-centered texting components. These findings suggest that text-based support might help parents assist their teens after an emergency room visit for suicide risk concerns. ^{4 6 7 8 9}

Who Is on the Research Team?

Ewa Czyz, PhD

Principal Investigator

University of Michigan

Are You a Good Fit for This Trial?

This trial is for parents of adolescents aged 13-17 who have visited the emergency department due to recent suicidal thoughts or attempts. The adolescent must be accompanied by a legal guardian, stable enough medically, and not severely cognitively impaired or aggressive.

Inclusion Criteria

I am a teenager who recently thought about or attempted suicide and I have a caregiver.

Exclusion Criteria

Adolescents presenting without a legal guardian

My parent does not own a cell phone.

I am a teenager and my health is currently unstable.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Parents receive up to 3 text messages per day over six weeks after ED discharge, including an embedded micro-randomized trial component

6 weeks

Daily virtual interactions

Follow-up

Participants are monitored for safety and effectiveness after treatment

12 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Text-based intervention

Trial Overview The study is testing an adaptive text-based support system aimed at helping parents manage after their teen has been in the ED for suicide risk. It's designed to see if texts can effectively provide guidance and support.

How Is the Trial Designed?

Group I: Standard ED care with a text-based intervention Experimental Treatment 1 Intervention

This arm incorporates adolescent-centered (A-C) and parent-centered (P-C) texting components Parents in the intervention arm will receive up to 3 text messages per day over six weeks after ED discharge: daily A-C text and up to two P-C messages. The P-C component includes an embedded micro-randomized trial (MRT), and parents will be randomized twice each day over the six-week intervention to either receive or not receive a P-C message.

Group II: Standard ED care Active Control 1 Intervention

Who Is Running the Clinical Trial?

University of Michigan

Lead Sponsor

Trials

1,891

Recruited

6,458,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Published Research Related to This Trial

An automated, self-guided Internet-based safety plan (IBSP) was developed and evaluated by 150 participants who reported suicidality, showing moderate perceived utility among users.

Participants generally believed the IBSP could be more helpful for others than for themselves, indicating a potential gap in personal recognition of its benefits, and males were less likely to complete the safety plan steps.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perceived Utility of the Internet-Based Safety Plan in a Sample of Internet Users Screening Positive for Suicidality. Spangler, DA., Muñoz, RF., Chu, J., 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]

The Virtual Hope Box (VHB) app was found to be more regularly used and preferred by high-risk patients and their clinicians compared to a traditional hope box, indicating its potential effectiveness in helping patients cope with negative thoughts and stress.

Patients reported that the VHB was beneficial, easy to set up, and expressed a strong likelihood of continued use and recommendation to others, suggesting its practicality as a therapeutic tool.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Virtual Hope Box smartphone app as an accessory to therapy: proof-of-concept in a clinical sample of veterans. Bush, NE., Dobscha, SK., Crumpton, R., et al.[2022]

The pilot phase of the SmartCrisis 2.0 trial demonstrated that a smartphone-based safety plan for patients with recent suicidal behavior is feasible and well-accepted, with a participation rate of 77% and high satisfaction ratings (overall satisfaction score of 9.6 out of 10).

Patients found the safety plan useful (7.4/10) and easy to use (8.9/10), with common coping strategies including walking and exercise, indicating that the app could be a valuable tool in clinical practice for supporting mental health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Smartphone-based safety plan for suicidal crisis: The SmartCrisis 2.0 pilot study. Porras-Segovia, A., De Granda-Beltrán, AM., Gallardo, C., et al.[2023]

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 pilot study involving 18 post-suicidal patients demonstrated that text messaging outreach is technically feasible and was well-accepted by participants, who reported a positive impact on their recovery.

Text messaging offers a cost-effective and convenient alternative to traditional post-acute care strategies, suggesting potential for broader implementation and the need for further research to evaluate its efficacy in preventing post-acute suicidal behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Post-acute crisis text messaging outreach for suicide prevention: a pilot study. Berrouiguet, S., Gravey, M., Le Galudec, M., et al.[2018]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7822725/

Text Message Interventions in Adolescent Mental Health and ... SMS text messaging is increasingly used as a method to deliver adolescent health services that promote psychological well-being and aim to protect adolescents.

2. mental.jmir.org mental.jmir.org/2024/1/e56407

Text Messaging to Extend School-Based Suicide Prevention This study conducted a pilot randomized controlled trial of Text4Strength in 1 high school as an extension of an ongoing schoolwide program.

3. psychiatryonline.org psychiatryonline.org/doi/10.1176/appi.ps.202000559

A Brief Text-Messaging Intervention for Suicidal Youths ... Finally, EHR data were examined to assess whether any participants had a repeat psychiatric visit within 6 months of consenting to participation ...

4. i-jmr.org i-jmr.org/2023/1/e47250

Phone-Based Text Therapy for Youth Mental Health This rapid review aims to understand the clinical effectiveness, usability, and accessibility of phone-based text therapy for youth mental health.

5. crisistextline.org crisistextline.org/data-philosophy/research-impact/

Research and Impact The results emerging from this study paint a picture of how volunteering at Crisis Text Line shapes the lives of Crisis Counselors, their relationships, and ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11904377/

Automated Digital Safety Planning Interventions for Young ... This study aims to identify the needs, preferences, and features for an automated SMS text messaging–based safety planning service to support ...

7. mental.jmir.org mental.jmir.org/2020/5/e17345/

Augmenting Safety Planning With Text Messaging Support for ... Objective: In this study of 40 adolescents at elevated suicide risk, we report on the iterative development and acceptability of a text-based ...

8. jamanetwork.com jamanetwork.com/journals/jamapediatrics/fullarticle/2834286

Safety Planning Interventions for Suicide Prevention in ... Results of this meta-analysis, however, suggest that in contrast to findings in adults, SPIs do not decrease SITBs for adolescents in crisis.

9. cdn.clinicaltrials.gov cdn.clinicaltrials.gov/large-docs/64/NCT05058664/Prot_SAP_001.pdf

Developing Text-based Support for Parents of Adolescents ... Chart data will also be abstracted to obtain relevant clinical information (e.g. psychiatric diagnoses, reason for hospitalization, previous hospitalizations).