Accepted for/Published in: JMIR Mental Health
Date Submitted: Jan 15, 2024
Date Accepted: May 28, 2024
Breaking down barriers to a suicide prevention helpline: a web-based randomized controlled trial
ABSTRACT
Background:
Every month, around 4,000 people complete an anonymous self-test for suicidal thoughts on the website of the Dutch suicide prevention helpline. Although 70% score high on the severity of suicidal thoughts, less than 10% navigates to the webpage about contacting the helpline.
Objective:
Our study aimed to test the effectiveness of a brief barrier reduction intervention (BRI) in motivating people with severe suicidal thoughts to contact the suicide prevention helpline, specifically in high-risk groups such as men and middle-aged people.
Methods:
A web-based randomised controlled trial. Respondents with severe suicidal thoughts and little motivation to contact the helpline were randomly allocated either to a brief BRI, in which they received a short tailored message based on their self-reported barrier to the helpline (N = 610) or a general advisory text (care as usual as control group, N = 612). Effectiveness was evaluated using both behavioural and attitudinal measurements. The primary outcome measure was the use of a direct link to contact the helpline after completing the intervention or control condition. Secondary outcomes were the self-reported likelihood of contacting the helpline and satisfaction with the received self-test.
Results:
In total, 2,124 website visitors completed the SIDAS and the demographic questions in the entry screening questionnaire. 1,222 of them were randomised into the intervention or control group. 772 respondents completed the RCT (N = 369 intervention group, N = 403 control group). The most selected barrier in both groups was ‘I don’t think that my problems are serious enough’. At the end of the trial, 33% of the respondents in the intervention group used the direct link to the helpline. This was not significantly different from the respondents in the control group (36%). However, the respondents who received the BRI did score higher on their self-reported likelihood of contacting the helpline at a later point in time (B = 0.22, SE = 0.05), and on satisfaction with the self-test (B = 0.27, SE = 0.13). For male and middle-aged respondents specifically, the results were comparable to that of the whole group.
Conclusions:
This trial was the first time the helpline was able to connect with high-risk website visitors who were hesitant to contact the helpline. Although the BRI could not ensure that those respondents immediately used the direct link to the helpline at the end of the trial, it is encouraging that respondents indicated that they were more likely to contact the helpline at a later point in time. In addition, this low coast intervention gave more insight into the perceived barriers to service. Follow-up research should be focused on identifying the added value of other components (e.g. video or photo material) in the BRI and increasing its effectiveness, especially for men and middle-aged people. Clinical Trial: ClinicalTrials.gov NCT05458830 International registered report identifier (irrid): PRR1-10.2196/41078.
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