Among youth at risk for suicide, a text messaging intervention may help reduce suicidal thoughts and behaviors after discharge from an emergency department, according to a report published in Psychiatric Services.
“Delivering caring contacts via text-messaging platforms is especially valuable in pediatric populations where most patients are comfortable with this mode of communication,” wrote Taylor Ryan, M.S., of Johns Hopkins University Bloomberg School of Public Health, Shawn Chambers, M.D., of Johns Hopkins University, and colleagues. “As the COVID-19 pandemic continues, the value and importance of using technology to deliver sustainable health care have become paramount.”
Ryan, Chambers, and colleagues recruited patients aged 12 to 17 who were seen in the Johns Hopkins Pediatric Emergency Department (PED) for suicidal thoughts or behaviors, or who screened positive for acute suicide risk on the Ask Suicide-Screening Questions tool to participate in a program evaluating the effectiveness of a text message intervention. The participants were required to have their own cell phones and were excluded if they were currently experiencing symptoms of psychosis or had a history of such symptoms.
The participants received one automated text message on days one, seven, 14, and 30 following their discharge from the emergency department. The four text messages were customized to address each patient by name, included a brief caring message (such as, “We are thinking about you and are wishing you the best.”), and encouraged patients to contact their community mental health provider or the Maryland crisis line if they were in crisis. Participants were told that the messages were automated and that they could not communicate directly with the sender, but they could reply “help” for a reminder to contact their provider if they were in distress.
After receiving all four messages, participants completed a phone survey, during which they reported their thoughts on the automated caring text messages and whether they believed the intervention helped reduce their suicidal thoughts and behaviors. Ryan, Chamber, and colleagues also examined electronic health record data to assess how many participants had a repeat pediatric emergency department visit within six months of enrolling in the study.
Thirty-seven youth consented to participate in the study, of whom 27 completed the follow-up survey. In total, 78% of survey respondents reported that the text messages had a positive impact on their mental health, 67% reported reduced suicidal ideation, and 74% reported that the messages helped prevent them from engaging in suicidal behavior. Nine of the 37 total participants had a repeat pediatric emergency department visit for psychiatric reasons during the follow-up period, with six participants returning within one month, one within three months, and two within six months.
“[A] text-messaging intervention may enable providers to maintain contact with patients and may even allow for providers to intervene if a patient experiences suicidal thoughts or behaviors,” the authors wrote. They noted that, during the study, a coordinator who was monitoring the system noticed that a participant messaged the platform saying, “I’m dying.” The coordinator and the project principal investigator reached the participant’s guardian at work, who “found that her child was in an acute suicidal crisis and was able to bring her child to our PED to initiate mental health care,” the authors wrote.
For related information, see the Psychiatric News article “Three-Day Intensive Crisis Intervention Found to Help Suicidal Youth.”
(Image: iStock/martin-dm)
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