Military Operational Medicine (JPC-5)
Texting: A Brief Intervention to Prevent Suicidal Ideation and Behavior
Posted September 12, 2018
Katherine Anne Comtois, Ph.D., M.P.H., University of Washington
Dr. Katherine Anne Comtois,
University of Washington
Due to the unwarranted stigma that surrounds mental health issues, individuals are often reluctant to seek help and/or treatment when they most need it. Potentially as a result of this attitude, suicide is a major cause of death in the United States, especially among males.1 From 2005-2009 there was a two-fold increase in the rate of suicide among active duty Service members, compared to other males in similar demographics.1 This rate has remained stable in recent years; however, there is substantial concern that these tragedies have struck individuals who lacked a history of suicidal behavior prior to enlistment.2 The risk of suicide to U.S. Service members, and thus national security, prompted Dr. Comtois, Principal Investigator of the Military Continuity Project, to develop a suicide intervention and prevention study with funding provided by the Military Suicide Research Consortium (MSRC). The MSRC is co-directed by Drs. Peter Gutierrez, Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver, Colorado and Thomas Joiner, Florida State University, Tallahassee, Florida and was funded through a U.S. Army Medical Research and Materiel Command Fiscal Year 2009 Broad Agency Announcement Award.
Based on well-established Caring Contact research and behavioral intervention studies using text messages, Dr. Comtois’ research team designed a study focusing on the use of Caring Contacts via Text (CCVT) as a suicide intervention and prevention strategy for at-risk active duty Service members. For the primary aim of the study, Dr. Comtois hypothesized that CCVT combined with Treatment as Usual (TAU) would lower suicidal ideation and suicidal risk incidents, including hospitalization or evacuation, compared to TAU alone. The secondary aim considered the factors of utilizing outpatient behavioral health services and “thwarted belongingness.” Thwarted belongingness was chosen as an element of this study because it has been identified as a dominant factor in suicide prevention.3 The research team hypothesized that CCVT would have its effect by reducing thwarted belongingness or increasing the use of outpatient behavioral health services.
The study recruited 657 active duty Marines and Soldiers from the Marine Corps bases at Camp Lejeune, North Carolina, and Twentynine Palms, California, and the U.S. Army base at Ft. Bragg, North Carolina, who reported suicidal ideation or had engaged in suicidal behaviors. These individuals were randomized into either an experimental group that received both CCVT and TAU or a control group that received TAU alone. During the course of this study, each CCVT participant received 11 non-demanding text messages over 12 months. Examples of these text messages included wishing someone a happy birthday and hoping that they have a good week. Responses or lack of responses to these text messages were tracked by the research staff, and necessary interventions were made, depending on whether a response was categorized as non-distress or crisis. The final assessment was conducted with the majority of the participants 12 months post-study. Results from these interviews showed that participants in the combination CCVT and TAU group were 43% less likely to have another suicidal ideation than those who received TAU alone. Furthermore, the CCVT and TAU group was 47% less likely to attempt suicide than the TAU group. The analysis of whether CCVT had its effect through reduced thwarted belongingness or increased engagement in behavioral health services is ongoing. However, preliminary analysis suggests that there is strong evidence to support directing more research toward CCVT as a suicide prevention and intervention strategy. CCVT is a low-cost, portable, implementation-ready, and simple method that can easily be combined with other suicide treatment and prevention activities to save the lives of Service men and women.
A long-term follow-up study of the Military Continuity Project, also funded by the MSRC, is planned. This study will add administrative data from a variety of sources and analyses will account for the implementation of the Marine Intercept Program.
The MSRC is dedicated to research that prevents suicide and, in doing so, urges anyone to act if they believe someone they know may be in danger. If you or someone you know has thoughts of suicide or has engaged in suicidal behaviors, contact the Military Crisis Line by texting 838255, calling 1-800-273-8255, or starting a confidential chat at MilitaryCrisisLine.net/.
1. Pruitt LD, Smolenski DJ, Bush NE, Skopp NA, Edwards-Stewart A, Hoyt TV. 2016. Department of Defense Suicide Event Report (DoDSER): Calendar Year 2016 Annual Report. National Center for Telehealth & Technology, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.
2. Kuehn BM. Soldier Suicide Rates Continue to Rise. 2009. JAMA. 301(11):1111–3.
3. Joiner T. Why People Die by Suicide. 2005. Harvard University Press. Cambridge, MA.
Last updated Wednesday, September 12, 2018