van der Burgt Margot C A, Mérelle Saskia, Brinkman Willem-Paul, Beekman Aartjan T F, Gilissen Renske
Department of Research, 113 Suicide Prevention, Amsterdam, Netherlands.
Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands.
JMIR Res Protoc. 2023 Apr 24;12:e41078. doi: 10.2196/41078.
Globally, suicide is among the leading causes of death, with men being more at risk to die from suicide than women. Research suggests that people with suicidal ideation often struggle to find adequate help. Every month, around 4000 people fill in the anonymous self-test for suicidal thoughts on the website of the Dutch suicide prevention helpline. This self-test includes the Suicidal Ideation Attributes Scale (SIDAS), which educates users about the severity of their suicidal thoughts. The vast majority (70%) of people who complete the self-test score higher than the cutoff point (≥21) for severe suicidal thoughts. Unfortunately, despite this, less than 10% of test-takers navigate to the web page about contacting the helpline.
This protocol presents the design of a web-based randomized controlled trial that aims to reduce barriers to contacting the suicide prevention helpline. The aim of this study is 2-fold: (1) to measure the effectiveness of a brief barrier reduction intervention (BRI) provided in the self-test motivating people with severe suicidal thoughts to contact the Dutch suicide prevention helpline and (2) to specifically evaluate the effectiveness of the BRI in increasing service use by high-risk groups for suicide such as men and middle-aged people.
People visiting the self-test for suicidal thoughts on the website of the suicide prevention helpline will be asked to participate in a study to improve the self-test. Individuals with severe suicidal thoughts and little motivation to contact the helpline will be randomly allocated either to a brief BRI, in which they will receive a short tailored message based on their self-reported barrier to the helpline (n=388) or care as usual (general advisory text, n=388). The primary outcome measure is the use of a direct link to contact the helpline after receiving the intervention or control condition. Secondary outcomes are the self-reported likelihood of contacting the helpline (on a 5-point scale) and satisfaction with the self-test. In the BRI, participants receive tailored information to address underlying concerns and misconceptions of barriers to the helpline. A pilot study was conducted among current test-takers to identify these specific barriers.
The pilot study (N=1083) revealed multiple barriers to contacting the helpline. The most prominent were the belief that a conversation with a counselor would not be effective, fear of the conversation itself, and emotional concerns about talking about suicidal thoughts.
Our study will provide insight into the effectiveness of a brief BRI designed to increase the use of a suicide prevention helpline provided in a self-test on suicidal thoughts. If successful, this intervention has the potential to be a low-cost, easily scalable, and feasible method to increase service use for helplines across the world.
ClinicalTrials.gov NCT05458830; https://clinicaltrials.gov/ct2/show/NCT05458830.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/41078.
在全球范围内，自杀是主要死因之一，男性自杀死亡风险高于女性。研究表明，有自杀念头的人往往难以获得足够的帮助。每月约有4000人在荷兰自杀预防热线的网站上填写关于自杀想法的匿名自测问卷。该自测问卷包括自杀意念属性量表（SIDAS），用于让用户了解其自杀想法的严重程度。绝大多数（70%）完成自测的人得分高于严重自杀想法的临界值（≥21）。然而不幸的是，尽管如此，不到10%的测试者会浏览到关于联系热线的网页。
本方案介绍了一项基于网络的随机对照试验的设计，旨在减少联系自杀预防热线的障碍。本研究的目的有两个：（1）测量在自测中提供的简短障碍减少干预（BRI）促使有严重自杀想法的人联系荷兰自杀预防热线的有效性；（2）具体评估BRI对增加男性和中年人等高自杀风险群体使用服务的有效性。
访问自杀预防热线网站进行自杀想法自测的人将被邀请参与一项改进自测的研究。有严重自杀想法且联系热线动力不足的个体将被随机分配到简短BRI组，他们将根据自己报告的联系热线的障碍收到一条简短的个性化信息（n = 388），或常规护理组（一般咨询文本，n = 388）。主要结局指标是在接受干预或对照条件后使用联系热线的直接链接的情况。次要结局指标是自我报告的联系热线的可能性（5分制）和对自测的满意度。在BRI中，参与者会收到个性化信息，以解决对联系热线障碍的潜在担忧和误解。对当前的测试者进行了一项试点研究，以确定这些具体障碍。
试点研究（N = 1083）揭示了联系热线存在的多种障碍。最突出的是认为与咨询师交谈不会有效、对交谈本身的恐惧以及对谈论自杀想法的情绪担忧。
我们的研究将深入了解旨在增加在自杀想法自测中提供的自杀预防热线使用的简短BRI的有效性。如果成功，这种干预有可能成为一种低成本、易于扩展且可行的方法，以增加全球各地热线服务的使用。
ClinicalTrials.gov NCT05458830；https://clinicaltrials.gov/ct2/show/NCT05458830。
国际注册报告识别号（IRRID）：PRR1-10.2196/41078。
