JMIR Publications

ABSTRACT

Background:

Suicide is a recognized global public health problem that is not improving in the United States. Veterans and service members are at particular risk. Caring Contacts is a simple, scalable intervention that reduces suicide risk in high-risk populations and has demonstrated acceptability in military and veteran samples. However, little is known about the mechanisms of Caring Contacts or its applicability to lower risk populations.

Objective:

The aims of this study are to 1) evaluate if receiving Caring Contacts reduces suicide risk for veterans recruited for stress or distress via Ecological Momentary Assessment (EMA; suicide urges and wish to live and die) and survey measures of suicidal ideation (Harkavy-Asnis Suicide Scale) and cognitions (Suicide Cognitions Scale); 2) examine diverse veterans’ experiences with Caring Contacts; 3) evaluate if receiving Caring Contacts reduces distress (depression, substance use consequences, hopelessness, defeat, and psychological pain); and 4) identify potential mechanisms of action for Caring Contacts (mattering, connectedness, social responsibility, and entrapment). With the use of EMA, this study will be the first to investigate mechanisms of Caring Contacts both as they are received in real-time as well as over one year.

Methods:

In this randomized controlled trial (RCT), 510 veterans or service members experiencing stress or distress will be offered the best available resources and randomized into one of three study conditions: (1) 12 months of Caring Contacts and monthly EMA, (2) 12 months of Caring Contacts without monthly EMA, or (3) 12 months of monthly EMA alone. The Caring Contacts conditions will receive 13 Caring Contacts messages over the course of the study year. A subset of participants from each condition will be asked to complete a qualitative interview after the 12-month follow-up about their experiences completing EMA and receiving Caring Contacts messages.

Results:

Recruitment for this trial started in April 2024 and will end in May 2025. Final quantitative data collection will be completed by July 2026, two months after the final 12-month follow-up date. Data from qualitative interviews will be collected until September 2026.

Conclusions:

This study will be the first RCT evaluating the impact of Caring Contacts on service members and veterans not recruited for suicidality. If effective, our findings will demonstrate that Caring Contacts are beneficial for multiple forms of psychological distress as well as suicide risk. In addition, we will evaluate potential mechanisms explaining the effect of Caring Contacts and the utility of EMA as a primary measure of outcome in suicide research trials. Clinical Trial: We are on clinicaltrials.gov at ID NCT06136234. This trial is currently enrolling participants.